laiKiiiT  \ 
UWARY    I 

BlOSClENCESLBBARr 


XUAL  IMPOTENCE 


IN  THE 


MALE  AND   FEMALE. 


WILLIAM  A.   HAMMO]^D,   M.    D., 

Surgeon-CJener al  U.  S.  Army  (retired  list) ;  Professor  of  Diseases  of  the  Mind  and 
Nervous  System,  at  the  New  York  Post-Graduate  Bledical  School,  etc. 


'"Nam  quicquid  essentia  dignum  est, 
id  etiam  scientia  dignum.'''' — Lord  Bacon. 


DETROIT: 

GEORGE  S.   DAVIS. 

1887. 


PREFACE. 


Probably  more  unhappiness  is  caused  by  Sexual 
Impotence  than  by  any  other  disease  that  afflicts  man- 
kind. This  httle  work  is  written  in  the  hope  that  my 
professional  brethren  may  find  it  of  service  to  them  in 
the  treatment  of  the  affection  in  question,  as  it  exists  in 
the  two  sexes.  The  first  edition,  published  nearly  three 
years  ago,  related  only  to  impotence  in  the  male.  The 
present  edition  considers  the  disorder  in  the  female  also. 
43  W.  44th  St.,  New  York,  May  i,  1SS7. 


CONTENTS. 


SECTION  I.— SEXUAL   IMPOTENCE   IN  THE   MALE. 


CHAPTER  I. 
Absence  of  Sexual  Desire. 
Original  Absence  of  all  Sexual  Desire — Acquired  Absence  of 
Desire— Mental  Preoccupation — Desire  Extinguished  by  Mastur- 
bation— Desire  Extinguished  by  Perversion  of  the  Sexual  Appetite 
— Treatment 1 1 

CHAPTER  II. 

Absence  of  the  Power  of  Erection  and  of  Consequent 
Intromission, 

Early  Sexual  Excesses — Sexual  Excesses  in  Adult  Life — Partial  Im- 
potence— Nocturnal  Emissions  —  Diurnal  Emissions  —  Obesity — 
Emaciation — Brain  Affections — Affections  of  Spinal  Cord — Dis- 
eases and  Injuries  of  the  Nerves— The  Effects  of  Excessive  Horse- 
back Riding — The  Effect  of  Certain  Medicines,  as  Iodine,  Nitrate 
of  Potash,  Alcoholic  Liquors,  Bromides,  etc.— Castration— Mental 
Causes — Excess  of  Desire — Superstition — Hypochondriacal  Con- 
dition— Pathology — Treatment — Hygienic  Measures— Marriage 
— Medical  Measures — External  Remedies— Internal  Remedies 93 

CHAPTER  III. 

Absence  of  the  Power  of  Ejaculating  the  Seminal  Fluid 
into  the  Vagina. 

The  Penis— Absence  of— Smallness  of — Great  Size  of— Bifurcation 
of— Suture  of— Anomalies  of  the  Urethra— Epispadias— Hypospa- 
dias—Stricture  of  the  Urethra— Spasmodic  Stricture— Paralysis  of 
the  Compressor  Urethrae  Muscle — Priapism— Anomalies  of  the 
Prepuce— The  Glans— The  Testicles— Absence  of— Arrest  of  the 
Development  of— Atrophy  of— Bodily  Deformity  or  Peculiari- 
ty—Contraction  of  Lower  Extremities  from  Disease  of  Spinal 
Cord— Tumors  of   Neighboring  Parts— Excessive  Corpulency 216 


CONTENTS— (Continued). 
CHAPTER    IV. 

Absence  of  the  Ability  to  Experience  Pleasure  During  the  Act 
OF  Copulation  and  During  the  Emission  of  the  Semen. 

The  Emotion  of  Love — Se.xual  Indifference — Loss  of  Sensibility  of 
Glans—  Effect  of  Circumcision — Extreme  Narrowness  of  Prepuce.  263 


SECTION   II.     SEXUAL   IMPOTENCE   IN   THE   FEMALE. 


CHAPTER  I. 
Absence  of  Sexual  Desire  Due  to  Absence  or  Arrest  of  Development 
of  the  Clitoris — To  Extreme  Smallness   of   the   Clitoris — Original 
Absence  of  Sexual  Desire 275 

CHAPTER   II. 

Inability  by  Reason  of  Pathological  Obstacles  to  allow  of  the 
Entrance  of  the  Penis  into  the  Vagina. 

Absence  of  the  Vulvar  Opening — Occlusion  of  the  Vulva — Vegeta- 
tions— Hernia — Great  Size  of  the  Clitoris — Absence  of  the  Vagina 
— Narrowness  of  the  Vagina — Density  of  the  Hymen 285 

CHAPTER  III. 
Vaginism 292 

CHAPTER  IV. 
Absence  of  the  Ability  to  Experience  the  Sexual  Orgasm 299 


f  Library  * 

A-  B.   Spiiier 


SEXUAL  IMPOTENCE. 


By  sexual  impotence  is  to  be  understood  an  impossi- 
bility or  difficulty  in  the  accomplishment  of  the  act  of 
copulation.  Impotence  in  the  male,  to  which  division 
of  the  subject  the  first  section  of  this  book  is  devoted, 
implies  the  existence  of  some  malformation,  disease,  or 
derangement  of  the  genital  organs,  either  primary  or 
secondary,  by  reason  of  which  there  is  either 

I.  Absence  of  sexual  desire. 

II.  Absence  of  the  power  of  erection  and  of  conse- 
quent intromission. 

III.  Absence  of  the  power  of  ejaculating  the  seminal 
fluid  into  the  vagina. 

IV.  Absence  of  the  ability  to  experience  pleasure 
during  the  act  of  copulation  and  at  the  time  of  the 
emission  of  the  semen. 

As  is  seen,  impotence  relates  altogether  to  the  act  of 
intercourse,  and  therefore  differs  from  sterility,  with 
which,  however,  it  is  often  confounded — the  latter  refer- 
ring only  to  the  inability  to  beget  offspring.  A  man 
may  be  impotent  without  being  sterile,  and  sterile  with- 
out being  impotent. 

Under  the  heads  as  just  given  1  propose  in  the  pres- 
ent section  to  consider  the  subject  of  sexual  impotence 
as  it  exists  in  the  male  of  the  human  species. 


10  SEXUAL   IMPOTEN'CE. 

In  SO  doing  1  shall  endeavor  to  correct  certain  er- 
roneous theories  which  are  very  generally  entertained, 
not  only  in  regard  to  the  normal  exercise  of  the  genera- 
tive organs,  but  also  relative  to  the  abuses  of  which 
they  are  the  subject.  And  I  shall  especially  consider 
several  forms  of  impotence  of  mental  origin,  which, 
though  probably  common  enough,  have  not  3'et,  1 
think,  received  the  attention  which  they  deserve. 

The  second  section  relates  to  sexual  impotence  as  it 
exists  in  the  female.  The  affection  in  women  is  by  no 
means  so  important  as  it  is  in  men.  Nevertheless,  it 
exists  and  is  often  the  cause  of  much  unhappiness.  1 
have  endeavored  to  treat  it  with  sufficient  thorough- 
ness.    It  is  considered  under  three  heads. 

I.  Absence  of  sexual  desire. 

II.  Inability  by  reason  of  physical  conditions  to  al- 
low of  the  entrance  of  the  penis  into  the  vagina. 

III.  Absence  of  the  ability  to  experience  the  sexual 
orgasm. 


CHAPTER   I. 

ABSENCE    OF   SEXUAL   DESIRE. 

Without  venereal  desire  the  act  of  sexual  inter- 
course would  probably  be  rarely  if  ever  performed. 
Ambroise  Pare,*  with  his  customary  plainness  of 
speech,  says : 

"A  certain  great  pleasure  accompanieth  the  function 
of  the  parts  appointed  for  generation  ;  and  before  it,  in 
living  creatures  that  are  of  a  lusty  age,  when  matter 
aboundeth  in  those  parts,  there  goeth  a  certain  fervent 
or  furious  desire  ;  the  causes  thereof  many,  of  which 
the  chiefest  is :  That  the  kind  may  be  preserved  and 
kept  forever  by  the  propagation  and  institution  of  other 
living  creatures  of  the  same  kind.  For  brute  beasts, 
which  want  reason,  and  therefore  cannot  be  solicitous 
for  the  preservation  of  their  kind,  never  come  to  carnal 
copulation  unless  they  be  moved  thereunto  by  a  certain 
vehement  provocation  of  unbridled  lust,  and,  as  it  were, 
by  the  stimulation  of  venery.  But  man  that  is  endowed 
with  reason,  being  a  divine  and  most  noble  creature, 
would  never  yield  nor  make  his  mind  so  subject  to  a 

*  "The  Works  of  Ambrose  Parey,  Chyrurgeon  to  Henry  II.,  Francis 
II.,  Charles  IX.,  and  Henry  III.,  Kings  of  France,"  etc.  London,  1691. 
Chapter  xxix.  ' '  JVhy  the  generative  parts  are  endowed  with  great  pleasure, " 
p.  534- 


12  SEXUAL   IMPOTE^'CE    IN   THE    MALE. 

thing  so  abject  and  filthy  as  is  carnal  copulation,  but 
that  the  venereous  ticklings  raised  in  those  parts  relax 
the  severity  of  his  mind  ;  or  reason  admonisheth  him 
that  the  memory  of  his  name  ought  not  to  end  with  his 
life,  but  to  be  preserved  unto  all  generations  as  far  as 
may  be  possible  by  the  propagation  of  his  seed  or 
issue." 

I.  Original  Absence  of  all  Sexual  Desire. — 
That  there  are  persons  in  apparent  good  health  who 
have  never  experienced  sexual  desires  is  undoubted, 
though  the  number  of  such  individuals  in  the  male  sex 
is  exceedingly  small.  It  is  said  that  Sir  Isaac  Newton 
never  had  sexual  intercourse,  and  the  fact  has  been 
brought  forward  as  an  illustration  of  the  point  in  ques- 
tion, but  I  think  unwarrantably.  In  all  my  experience 
but  two  cases  of  the  kind  have  come  under  my  observa- 
tion,  and  these  are  of  so  interesting  a  character  that  1 
do  not  hesitate  to  give  the  details  in  this  place. 

Mr.  W.,  aged  33,  a  strong,  well-built,  and  apparently 
healthy  man,  consulted  me,  December  11,  i860,  in  order, 
as  he  said,  to  ascertain  if  an3-thing  could  be  done  for 
him.  He  stated  that  he  had  never  experienced  the 
slightest  desire  for  sexual  intercourse  nor  any  venereal 
excitement,  though  the  latter  he  had  repeatedly,  by 
reading  libidinous  books  and  association  with  lewd 
women,  endeavored  to  produce.  So  far,  however,  from 
the  wished-for  effect  resulting,  the  consequence  was 
alwavs  the  opposite,  his  repugnance  increasing,  and  if 
the  attempts  were  persevered  with,  nausea  and  vomit- 


ABSENCE   OF   SEXUAL   DESIRE.  13 

ing,  accompanied  with  nervous  and  physical  prostration, 
ensued.  He  declared  that  he  had  never  practiced  mas- 
turbation, but  that  since  he  had  attained  the  age  of 
seventeen  he  had  had  in  his  sleep  what  he  supposed 
were  seminal  emissions,  about  once  in  two  or  three 
months.  Upon  one  occasion  he  had  persisted  in  the 
attempt  at  intercourse,  notwithstanding  the  absence  of 
desire  and  the  unpleasant  mental  and  physical  phenom- 
ena which  were  produced;  but  though  there  was  a 
vigorous  erection  caused  by  manual  solicitation  on  the 
part  of  the  Circe  upon  whom  the  attempt  was  made, 
this  was  at  once  dissipitated  as  soon  as  entrance  was  at- 
tempted. He  was  then  about  twenty-two  years  of  age 
and  the  experiment  taught  him  that  there  might  be  plea- 
sure in  masturbation.  As  I  have  said,  however,  he  was 
very  emphatic  in  declaring  that  he  had  never  indulged 
in  this  vice  ;  and  as  his  language  and  manner  were  frank 
in  the  extreme  I  have  no  reason  to  doubt  the  truth  of 
his  declaration.  Frequently,  as  he  had  informed  me, 
he  had  endeavored  to  excite  desire  by  imagining  erotic 
scenes  of  various  kinds,  but  though  erections  were  pro- 
duced, there  was  no  desire.  On  the  contrary,  feelings 
of  repugnance  and  disgust  were  at  once  excited. 

Here  apparently  there  was  the  ability  to  experience 
erections  from  psychical  and  tactile  excitations,  but 
the  sexual  appetite  appeared  to  be  undeveloped,  and 
in  addition  there  was  the  remarkable  idiosyncras}'  of 
disgust  instead  of  pleasure  being  excited  at  the  idea 
of  copulation.     But,  for  this  latter  circumstance,  the 


14  SEXUAL   IMPOTENCE   IN   THE   MALE. 

patient  could  undoubtedly  have  mechanically  gone 
through  the  act  of  intercourse,  and  perhaps  have  ex- 
perienced pleasure  from  the  operation. 

There  were  many  reasons  why  this  gentleman  should 
marry.  There  was  a  considerable  property  held  in  trust 
for  any  children  he  might  have,  but  which  without 
offspring  of  his  would  go  from  his  family  partly  to 
people  strangers  to  him  and  partly  to  certain  charita- 
ble institutions.  And  again,  strange  as  it  may  seem, 
he  liked  the  companionship  of  women  and  was  anxious 
to  have  a  home  of  his  own,  and  a  wife  with  whom  he 
might  at  least  associate  in  a  platonic  way.  In  his  pres- 
ent condition,  he  felt  that  all  these  things  were  impos- 
sible, and  so  he  had  come  to  me  hoping  that  in  the  re- 
sources of  medicine  there  might  be  something  that 
would  alter  his  nature  so  as  to  make  sexual  intercourse 
possible  to  him,  even  if  the  development  of  desire  were 
out  of  the  question. 

I  saw  no  way  of  doing  this,  however,  unless  it  might 
be  possible  for  him  to  accomplish  the  sexual  act  not- 
withstanding the  disgust,  the  faintness,  the  nausea  and 
vomiting,  and  by  perseverance  to  overcome  the  idio- 
syncrasy. He  promised  to  make  the  attempt  repeat- 
edly, but  he  reported  about  a  month  afterward  that  the 
plan  of  treatment  was  impossible.  He  went  into  the 
civil  war,  and  was  killed  at  either  Antietam  or  Gettys- 
burg. 

In  the  other  case  the  patient,  a  man  27  years  of  age, 
had  never  experienced  sexual  desire,  though   the  or- 


ABSENCE    OF   SEXUAL   DESIRE.  1 5 

gans  were  of  full  size  and  well-formed.  Erections  were 
readily  produced  by  frictions  of  the  penis,  or  by  the 
application  of  heat,  or  even  by  lying  on  the  back ;  but, 
instead  of  the  ordinary  venereal  desires  being  excited, 
there  was  an  overwhelming  inclination  to  drink  alco- 
holic liquor  in  large  quantities,  and  a  drunken  debauch 
was  the  consequence.  Towards  women  there  was  a 
strong  feeling  of  disgust,  and  a  still  more  powerful  dis- 
inclination to  sexual  intercourse.  Many  times  the  at- 
tempt to  effect  entrance  had  been  made  while  an  erec- 
tion existed,  but  at  once  the  penis  became  flaccid.  In 
this  instance,  there  was  the  reciprocal  effect  of  erec- 
tions being  produced  by  the  desire  for  alcohol,  and 
under  such  a  circumstance  masturbation  had  often  been 
practiced.  This  patient  eventually  died  comatose  dur- 
ing a  severe  attack  of  cerebral  congestion. 

II.  Acquired  Absence  of  Desire. — There  are  vari- 
ous circumstances  which  exert  an  influence  in  abolish- 
ing the  natural  sexual  desire  of  the  individual.  Among 
these  are  : 

a.  Mental  preoccupation. — It  is  well  known  that  when 
the  mind  is  intensely  engaged  with  engrossing  subjects 
of  a  character  foreign  to  the  animal  passion,  venereal 
excitement  is  not  experienced.  Every  man  is,  more  or 
less,  familiar  with  this  fact  from  his  own  experience, 
and  in  the  majority  of  cases  the  impotence  thus  in- 
duced is  of  a  temporary  character — the  desire  return- 
ing with  the  cessation  of  the  mental  preoccupation. 
But,  in  some  instances,  the  mind  is  so  continuously  ab- 


l6        SEXUAL  IMPOTENCE  IN  THE  MALE. 

sorbed  with  other  thoughts  and  emotions  that  the  sex- 
ual appetite  is  altogether  abolished,  and  does  not  return 
even  if  there  be  periods  of  intellectual  or  emotional  re- 
laxation. Sir  Isaac  Newton,  it  is  said,  never  had  sex- 
ual intercourse.  Perhaps  it  would  be  going  too  far  to 
say  that  he  never  experienced  the  desire  ;  but,  occupied 
as  his  mind  was  with  subjects  requiring  the  most  severe 
and  continuous  thought,  it  is  quite  probable  that  he  was 
from  this  cause  practically  incapable  of  copulation. 
The  mere  diversion  of  the  mind,  even  for  an  instant,  is 
sufficient,  as  Sterne  has  ludicrously  reminded  us,  to 
render  a  man  temporarily  sexually  impotent. 

Of  this  temporary  impotence  from  a  sudden  cessa- 
tion of  the  desire  by  the  thoughts  being  suddenly  di- 
verted into  another  channel  during  the  act  of  sexual 
intercourse,  several  interesting  cases  have  come  under 
my  observation. 

A  gentleman,  a  married  man,  and  the  picture  of  ro- 
bust health,  consulted  me  for  a  trouble  of  the  kind  un- 
der which  he  labored.  He  had  been  recently  married 
and  was  much  attached  to  his  wife,  but  for  a  year  past 
whenever  he  had  attempted  sexual  intercourse  some 
thought  often  of  a  ludicrous  character  would  take  pos- 
session of  his  mind,  and  extinguish  all  desire  at  the 
very  moment  that  the  orgasm  was  beginning.  At  once 
the  penis  became  flaccid  and  the  act  remained  un- 
accomplished. As  an  instance,  he  informed  me  that  the 
previous  night  he  had  made  an  effort  to  have  connection 
with  his  wife.     The  erection  was  vigorous,  but  just  as 


ABSENCE   OF   SEXUAL   DESIRE.  IJ 

the  acme  was  being  reached  a  funny  story  he  had  read 
that  day  in  a  comic  newspaper  flashed  through  his 
mind.  His  desire  at  once  vanished,  the  penis  lost  its 
turgescence  and  the  emission  did  not  take  place.  On  a 
previous  occasion,  under  similar  circumstances,  the 
thought  of  a  purchase  he  had  concluded  occurred  to 
him,  and  a  like  result  ensued. 

These  repeated  failures  and  disappointments  had 
created  a  great  deal  of  mental  disturbance.  He  had 
become  low-spirited  almost  to  the  point  of  melancho- 
lia, and  had  several  times  entertained  serious  thoughts 
of  suicide. 

In  another  case,  the  patient,  a  young' man,  whose 
mind  was  severely  taxed  by  the  nature  of  his  occupa- 
tion, which  was  that  of  a  professional  gambler,  experi- 
enced when  his  nightly  work  was  over  strong  sexual 
desires  which  he  was  unable  to  gratify,  for  in  the  act  of 
intercourse  some  technical  matter  connected  with  his 
business  was  sure  to  come  up  in  his  mind  with  the 
effect  of  extinguishing  all  desire  and  with  it  all  power. 
In  both  these  cases  and  in  others  which  have  come 
within  the  range  of  my  personal  experience,  I  found 
that  the  subjects  were  extremely  impressionable  individ- 
uals, and  that  the  first  occurrence  of  the  kind  which  in 
most  other  persons  would  have  made  no  lasting  im- 
pression on  the  mind  produced  with  them  such  an 
effect  that  at  the  next  attempt  at  intercourse  the  fear 
was  excited  that  a  repetition  of  the  disturbance  would 
ensue,  and  as  a  consequence  the  apprehension  was  rea- 


1 8  SEXUAL   IMPOTENCE   IX   THE    MALE. 

lized.  After  that,  on  every  similar  attempt,  there  was 
a  like  fear  that  some  thought  would  obtrude  itself,  and 
owing  to  the  exercise  of  the  principle  of  "  expectant 
attention,"  the  thing  upon  which  the  mind  was  concen- 
trated and  which  was  so  greatly  feared  occurred  with 
painful  punctuality.  It  is  an  essential  feature  to  the 
due  performance  of  sexual  intercourse  that  the  man 
should  have  confidence  in  himself.  If  this  is  weakened, 
aud  still  more  if  it  is  destroyed,  disappointment  is  sure 
to  result,  and  a  condition  of  impotence  is  established. 

In  the  treatment  of  cases  of  this  nature,  u  is  neces- 
sary in  the  first  place  to  rid  the  patient  of  his  ap- 
prehension,*so  that  he  will  make  the  attempt  without 
experiencing  the  slightest  fear  that  anything  is  going 
to  occur  to  interrupt  the  normal  performance  of  the 
act.  The  only  way  with  which  I  am  acquainted  by 
which  this  can  be  done  is  for  the  patient  to  abstain  ab- 
solutely from  all  attempts  for  several  months.  By  this 
course  the  appetite  usually  becomes  so  strong,  in  a  man 
otherwise  vigorous,  that  the  desire  overrides  all  possi- 
ble fears,  and  when  once  this  result  can  be  attained 
there  is  no  longer  any  danger  of  a  recurrence  of  the 
trouble. 

1  therefore  advised  the  married  gentleman  to  occupy 
a  separate  room  from  that  used  by  his  wife,  and  on  no 
account  to  attempt  intercourse  for  three  months;  I 
expected  by  this  course  to  break  up  the  habit  into 
which  his  brain  had  fallen  of  associating  incongruous 
ideas  with  the  act  of  intercourse,  as  well  as  to  allow 


ABSENCE   OF  SEXUAL   DESIRE.  19 

the  center  for  the  sexual  appetite,  to  acquire,  by  re- 
pose, increased  strength.  With  similar  objects  in  view, 
I  advised  the  other  patient  to  take  a  sea  voyage  which 
he  had  in  contemplation,  and  not  to  attempt  intercourse 
till  his  return,  which  would  not  be  for  a  period  of 
nearly  four  months.  The  treatment  was  so  perfectly 
successful  with  both  subjects  that  there  was  not  the 
least  difficulty  when  the  periods  of  probation  had  ex- 
pired. 

In  another  case,  the  patient,  a  civil  engineer,  and 
engaged  m  work  requiring  extensive  mathematical  cal- 
culations, found  that  his  desires  were  altogether  ex- 
tinguished. There  was  nothing  very  astonishing  in 
this,  for  such  studies  are  of  all  things  most  calculated 
to  divert  the  mind  from  sexual  matters  and  to  extin- 
guish desire.  So  powerful  is  this  influence,  that  MM. 
Grimaud  de  Caux  and  Martin  Saint  Ange  *  advise  the 
reading  of  mathematical  treatises  as  one  of  the  most 
effectual  means  of  subduing  excessive  venereal  excite- 
ment. Moreover,  Broussais  f  has  observed  that  the 
genesic  power  is  weakened  by  the  mental  concentration 
required  in  mathematical  studies.  In  his  lectures  on 
phrenology  delivered  before  the  Faculty  of  Medicine  of 
Paris,  he  not  only  insisted  upon  this  point,  but  he  ex- 
hibited two  heads  of  eminent  deceased  mathematicians 
who  not  only   were  never  married  but  who    had  an 


*  "Histoire  de  la  generation  de  I'homme,"  Paris,  1847,  p.  294. 
f  "Cours  de  phrenologie,"  Paris,  1836,  p.  183. 


20        SEXUAL  IMPOTENCE  IN  THE  MALE. 

aversion  to  the  female  sex  and  who  had  never,  as  was 
said,  had  sexual  intercourse.* 

But  to  return  to  the  case  of  the  engineer :  while  oc- 
cupied with  the  calculations  requisite  to  the  higher  per- 
formance of  the  extensive  work  on  which  he  was  en- 
gaged, and  which  required  about  fourteen  houi's  daily 
of  severe  mental  labor,  he  experienced  no  sexual  desire 
and  did  not  for  over  a  year,  though  a  married  man, 
attempt  intercourse.  Indeed,  his  repugnance  thereto 
was  so  great  that  for  fear  he  might  be  tempted  he  had 
induced  his  wife  to  make  a  visit  to  Europe,  and  she  had 
been  absent  several  months,  and  had  just  returned 
when  the  case  was  brought  to  my  attention. 

Soon  after  her  reappearance  in  his  home,  he  had,  so 
he  informed  me,  more  as  a  matter  of  duty  and  affec- 
tion, than  from  any  venereal  inclination  on  his  part, 
attempted  sexual  intercourse,  but  had  miserably  failed. 
There  was  no  desire,  and  it  was  impossible  to  reawaken 
an  appetite  that  had  long  been  extinguished.  Such  a 
state  of  affairs  could  not  long  continue  without  the 
peace  and  harmony  which  had  hitherto  existed  in  his 
family  being  in  great  danger  of  disturbance.  Already 
he  was  fearful  that  his  wife  would  attribute  his  impo- 
tence to  excesses  with  other  women,  and  so  he  had 
determined  to  take  medical  advice  in  regard  to  his 
disorder. 

I  found,  on  examination,  that  there  was  no  trouble 

*  Op.  cit.  p.  i8o. 


ABSENCE   OF   SEXUAL   DESIRE.  21 

with  the  functions  or  structure  of  the  genital  organs. 
The  penis  was  of  full  size,  and  the  testicles  were  large, 
firm  and  free  from  disease.  Nocturnal  emissions  oc- 
curred on  an  average  about  once  a  month,  generally 
with,  but  sometimes  without,  lascivious  dreams.  Erec- 
tions often  took  place  during  the  night,  and  were  pain- 
ful, but  were  unaccompanied  with  desire.  Apparently 
they  were  the  result  of  congestion  of  the  cord  from 
lying  on  the  back,  and  from  distension  of  the  bladder 
with  urine.  The  patient  was  satisfied  that  if  his  desires 
could  once  be  awakened  there  would  be  no  difficulty  in 
the  physiological  performance  of  the  sexual  act,  and 
he  was  now  anxious  that  they  should  be  restored  to 
their  former  degree  of  activity.  For  while  there  had 
never  been  excesses,  there  had,  up  to  the  beginning  of 
the  period  mentioned,  been  a  full  degree  of  sexual  in- 
clination and  power.  Conversation,  however,  with 
him,  convinced  me  that  there  was  no  anxiety  on  his 
part  for  the  restoration  of  his  sexual  health  based  upon 
any  other  feelings  than  a  regard  for  the  proprieties  of 
the  situation  and  a  fear  of  the  ultimate  consequence  to 
his  health  and  his  domestic  felicity.  As  to  venereal 
appetite  there  did  not  appear  to  be  a  vestige. 

Upon  mature  reflection  I  saw  no  way  of  materially 
benefitting  the  patient  except  by  his  giving  up  his  work 
for  a  time  and  devoting  himself  entirely  to  the  society  of 
his  wife.  At  the  same  time  I  advised  the  application  of 
statical  electricity  to  the  nape  of  the  neck  with  the  view 
of   obtaining  its  counter-irritant  action,  as  well  as  its 


2  2  SEXUAL   IMPOTENCE    IN    THE    MALE. 

expectant  effect  on  the  mind  of  the  patient.  So  strong 
were  the  motives  by  which  he  was  actuated  that  he  at 
once  resigned  his  very  lucrative  situation  and  sub- 
mitted himself  to  the  treatment  advised.  He  purchased 
a  little  villa  near  the  city,  moved  into  it  with  his  wife, 
and  practically  renewed  his  courtship  of  seven  years 
previously.  In  accordance,  further,  with  my  advice, 
he  made  no  attempts  at  intercourse,  but  waited  patient- 
ly for  the  revivification  of  his  desires.  His  restoration 
to  health  was  not  long  postponed,  for  within  three 
months  he  began  to  experience  propensities  to  which 
for  so  long  a  time  he  had  been  a  stranger,  and  after  that 
the  complete  recovery  was  well  assured.  Aided  by 
the  good  sense  of  his  wife,  to  whom  I  fully  explained 
the  situation,  and  who,  confident  of  possessing  her  hus- 
band's affections,  acted  throughout  with  rare  kindness 
and  discretion,  there  was  no  interruption  to  the  course 
of  his  restoration.  He  will  not  soon  forget,  however, 
that  Urania  is  a  more  exacting  and  exhausting  mistress 
than  Venus  herself. 

A  case  is  cited  by  Grimaud  de  Caux  and  Saint  Ange  in 
which  a  celebrated  mathematician  was  always  diverted 
from  the  complete  performance  of  the  sexual  act  by  the 
recurrence  to  his  mind  of  problems  of  geometry,  or  of 
equations  which  had  occurred  to  him  during  the  day. 
The  treatment  was  different  from  that  which  I  have 
recommended  in  similar  cases,  and  consisted  in  his  wife 
being  advised  not  to  allow  the  approaches  of  her  hus- 
band unless  he  was  in  a  state  of  semi-intoxication.     It 


ABSENCE   OF   SEXUAL   DESIRE.  23 

was  hoped  that  by  this  means  his  intelligence  would 
be  sufficiently  weakened  to  allow  of  the  exclusive  em- 
pire of  the  sexual  appetite  over  his  mind.  It  is  sta- 
ted that  entire  success  was  the  result.  It  appears  to 
me,  however,  that  the  plan  I  have  advised  is  on  every 
account  altogether  preferable,  especially  as  it  has  been 
uniformly  successful. 

There  is  a  good  deal  of  sexual  indifference,  and  con- 
sequently of  impotence,  existing  among  men  whose 
whole  heart  and  soul  are  in  exciting  business  occupa- 
tions requiring  all  their  mental  energy  and  consequent- 
ly leaving  nothing  for  the  mere  animal  passions.  Such 
individuals  have  no  pleasures  in  life  beyond  those  con- 
nected with  the  acquisition  of  wealth — society,  the  din- 
ing-table,  the  card-table,  the  theatre,  the  opera,  litera- 
ture, amusements,  good  or  bad,  never  allure  them. 
If  they  are  married  they  go  to  bed  to  sleep,  if  they  can, 
for  they  are  exhausted  with  the  excitements  and  the  anx- 
ieties of  the  day.  If  unmarried  they  return  at  evening 
to  their  solitary  apartments  to  study  the  markets  and 
to  devise  new  combinations.  Sexual  intercourse  is  a 
matter  of  utter  indifference ;  their  desires  are  extin- 
guished. 

It  is  rarely  the  case  that  the  physician  is  consulted 
by  such  people  till,  having  accomplished  their  business 
objects,  or  failed  in  them,  they  find  not  only  that  they 
have  no  desire,  but  that  it  is  impossible  to  re-arouse  the 
sexual  appetite.  While  it  is  true  in  other  things  that  a 
man  does  not  regret  the  loss  of  that  which  he  does  not 


24  SEXUAL   IMPOTENCE   IN   THE    MALE. 

value  it  is  very  different  as  regards  sexual  matters. 
And  though  a  person  such  as  that  referred  to  cares 
nothing  for  his  virile  power  as  such,  there  are  secon- 
dary considerations  which  he  feels  he  cannot  disregard. 
Among  these  are  the  fear  that  in  losing  his  sexual  appe- 
tite he  is  laying  the  ground-work  for  future  paralysis, 
even  if  the  loss  be  not  one  of  the  early  signs  of  the  ap- 
proach of  that  disease,  the  desire  for  offspring  to 
whom  he  may  transmit  his  wealth,  and  if  single  the 
wish  for  the  comforts  of  a  home  and  the  society  of 
some  cultivated  and  refined  woman. 

Such  cases  are,  however,  dilificult  to  manage.  The 
thoughts,  the  emotions,  the  appetites  even,  have  for  so 
long  a  time  been  concentrated  toward  one  particular 
point,  that  the  task  of  diverting  them  into  other  chan- 
nels is  almost  insurmountable.  A  second  nature  has 
been  formed  with  objects  in  life  and  desires  different 
from  those  originally  inherent  in  the  individual.  Be- 
sides, with  the  diminution  of  the  natui'al  inclination  for 
sexual  intercourse  there  is  very  often,  in  these  instances, 
a  veritable  loss  of  generative  power,  and  the  two  con- 
ditions reacting  on  one  another  render  the  prognosis 
still  more  unfavorable.  Still  there  are  cases  in  which 
the  power  is  simply  detcrioi-atcd  from  its  normal  stand- 
ard. To  such  the  society  of  agreeable  and  virtuous 
women  mav  be  recommended  as  constituting  an  effi- 
cient aid  to  the  other  measures  proposed.  These 
should  consist  of  entire  change  of  habits  and  the  devo- 
tion of  a   considerable   jx^rtion  of  the  time   lo  amuse- 


ABSENCE   OF   SEXUAL   DESIRE.  2$ 

ments,  physical  exercise,  and  pursuits  tending  to  the 
development  of  emotions  different  from  those  which 
have  previously  actuated  him.  Nothing  can  be  better 
than  the  entire  cessation  of  business  pursuits  and  the 
undertaking  of  a  course  of  foreign  travel. 

The  treatment  must  be  mainly  moral  and  hygienic, 
but  I  think  if  there  is  the  least  suspicion  of  any  impair- 
ment of  the  general  health  strychnia  in  small  doses 
taken  for  a  long  time  will  be  of  service.  I  am  quite 
sure  I  have  derived  benefit  from  the  administration  of 
a  prescription  consisting  of  one  grain  of  the  sulphate 
of  strychnia  to  the  ounce  of  water,  the  patient  taking 
ten  drops  three  times  a  day  shortly  before  meals. 

Usually,  even  in  mild  cases,  several  months  are  re- 
quired before  the  extinguished  sexual  feeling  is  rekin- 
dled, and  there  is  a  still  longer  period  before  the  normal 
degree  of  desire  is  obtained.  In  those  instances  in 
which  there  is  also  a  loss  of  sexual  power  the  prospect 
of  recovery  is,  as  I  have  said,  still  more  remote ;  but 
the  further  consideration  of  this  class  of  cases  is  more 
appropriate  to  the  following  chapter. 

b.  Desire  Extinguished  by  Masturbation. — The  normal 
sexual  appetite  and  a  condition  of  impotence  are  in- 
duced by  masturbation  when  carried  to  excess,  and  this 
altogether  independently  of  the  loss  of  power  which  in 
such  cases  eventually  ensues.  The  imagination  is  al- 
ways a  more  potent  excitor  of  the  sexual  desire  than 
the  physiological  incentive  supplied  by  nature.  The 
masturbator  relies  on  the  fertility  and  extravagance  of 


26  SEXUAL   IMPOTENXE    IX   THE   MALE. 

the  lewd  images  presented  to  his  mind  for  the  increase 
of  the  pleasure  derived  from  his  act,  and  frequently  he 
adds  to  the  vividness  by  reading  obscene  books  or  look- 
ing at  filthy  pictures.  As  he  goes  on  he  finds,  in  obe- 
dience to  a  law  of  the  organism,  that  graduall}'  the 
visions  which  once  sufficed  to  produce  the  requisite 
venereal  excitement  have  lost  their  power,  just  as  some 
strongl}'  savored  substance  would,  if  eaten  for  a  long 
time,  fail  to  produce  pleasant  impressions  on  the  gusta- 
tory papillcc.  Still  more  libidinous  and  unnatural  repre- 
sentations are  conceived  b}'  his  mind  and  brought  before 
his  mental  vision,  and  so  on,  till  at  last,  should  he  at- 
tempt sexual  intercourse,  he  finds  that  the  reality  is  so 
much  less  than  his  imagination  had  led  him  to  believe, 
that  it  is  incapable  of  sufficientlv  rousing  his  appetite. 
He  is,  in  fact,  impotent  to  women  ;  he  no  longer  desires 
intercourse,  but  abandons  himself  to  his  fatal  habit, 
knowing  the  almost  limitless  resources  of  his  imagina- 
tion in  providing  excitations  to  his  desires.  Such  per- 
sons shun  the  society  of  women,  become  often  true 
misogynists,  and  suffer  an  entire  extinction  of  the  sexual 
feeling. 

Such  cases  are  to  be  discriminated  from  those,  much 
more  common,  in  which  there  is  a  loss  of  the  power  of 
erection,  a  condition  which  sooner  or  later  is  the  conse- 
quence of  continued  masturbatory  excesses.  The  one 
is  altogether  a  mental,  the  other  a  physical  phenomenon, 
though  very  often  both  states  exist  in  the  same  indi- 
vidual. 


ABSE^XE   OF   SEXUAL   DESIRE.  2'J 

A  3-oung  man,  whose  father  wished  him  to  marry, 
had  been  continually  putting  off,  on  one  pretext  or 
another,  acceding  to  the  paternal  wishes,  till  at  last  he 
confessed  that  he  had  no  desire  for  sexual  intercourse, 
and  begged  that  in  future  he  might  be  let  alone.  The 
father,  alarmed  for  his  son's  health,  insisted  on  his  con- 
sulting a  physician,  and  at  last,  through  much  impor- 
tunity, succeeded  in  getting  his  consent,  and  he  came 
under  my  observation.  At  his  first  visit  to  me  the 
yoimg  man  requested  that  his  father  would  leave  the 
room,  and  then  as  soon  as  we  were  alone  he  confessed 
that  for  several  years  he  had  practiced  masturbation, 
but  only  in  moderation,  that  occasionally  he  had  had 
sexual  intercourse,  and,  as  he  said,  under  circumstances 
favorable  to  the  due  physiological  performance  of  the 
act,  but  that  after  a  mature  consideration  of  all  the 
points  bearing  upon  the  case,  he  had  arrived  at  the  con- 
clusion that  masturbation  gave  greater  pleasure  and 
was  altogether  less  troublesome.  In  fact,  that  he  had 
no  desire  whatever  for  sexual  intercourse,  but  preferred 
to  go  on  in  the  way  he  had  begim  and  which  he  was 
frank  enough  to  say  was  entirel}'  satisfactory  to  him. 

I  endeavored  to  point  out  to  him  the  inevitable  con- 
sequences of  the  course  he  was  pursuing,  so  far  as  his 
sexual  power  was  concerned,  as  well  as  the  mental 
degradation  that  was  certain  to  ensue;  but  all  in  vain, 
and  when  he  left  me  I  had  made  up  my  mind  that  his 
was  one  of  those  cases  of  sexual  perversion,  to  the  con- 
sideration of  which  I  shall  presently  come,  and  that  a 


28  SEXUAL   IMPOTENCE   IX   THE   MALE. 

cure  by  medical  means  was  out  of  the  question.  The 
coolness  and  effrontery  with  which  he  conversed  about 
the  subject,  and  the  reasons  which  he  had  to  urge  in 
his  behalf,  led  me  to  this  belief  and  also  to  the  further 
conviction  that  there  was  a  streak  of  insanity  in  his 
composition  which  would  some  day  become  wider  and 
probably  entirel}^  overwhelm  him.  I  neither  saw  nor 
heard  anything-  of  him  until  one  day  about  a  year  after- 
ward he  entered  my  consulting-room  in  company  with 
a  rather  pretty  young  woman,  whom  he  introduced  as 
his  wife.  Requesting  her,  after  I  had  congratulated 
him,  to  step  into  the  adjoining  room,  he  informed  me 
that  after  leaving  me  a  year  before  he  had  thought 
over  seriously  what  I  had  said  to  him,  and  had  finally 
arrived  at  the  conclusion  that  I  was  right,  and  that  he 
would  endeavor  to  change  his  course.  He  went  so  far 
as  to  pay  several  visits  to  the  young  lady  his  father 
wished  him  to  marry,  but  compliance  in  that  direction 
he  found  was  entirely  out  of  the  question.  Then  he 
had  for  a  while  frequented  houses  of  prostitution,  but 
had  never  been  able  to  bring  himself  to  the  point  of 
attempting  sexual  intercourse.  He  had  his  own  ideas 
of  morality  and  decency  and  in  his  way  was  ver}^  con- 
scientious, and  these  circumstances  influenced  him 
somewhat,  but  the  main  reason  was  that  he  had  a  deep- 
ly-rooted disgust  for  the  sexual  act  and  all  its  accom- 
paniments, especially,  so  he  said,  with  women  who 
made  a  trade  of  its  performance. 

Then  he  had  thought  of  forming  permanent  relations 


ABSENCE   OF   SEXUAL   DESIRE.  29 

with  some  one  woman  in  order  first  to  ascertain  if  he 
were  capable  of  doing  his  part  in  the  marriage  relation. 
He  took,  as  he  said,  one  who  he  thought  would  answer 
the  purpose,  but  after  a  week's  residence  with  her  he  sev- 
ered the  association,  having  been  unable  to  rouse  suffi- 
cient desire  to  induce  aim  to  make  any  effort  at  con- 
nection. 

But  about  a  month  before  his  return  to  me  he  had 
visited  a  circus  tha^,  was  passing  through  a  village  at 
which  he  was  staying  with  a  friend.  Here  he  had  be- 
come suddenly  enamored  with  a  young  woman,  one  of 
the  performers,  who  rode  a  bare-backed  horse  with 
great  agility  and  daring.  He  made  propositions  to  her 
which  she  indignantly  rejected,  and  finally  offered  mar- 
riage. He  was  at  once  accepted,  the  knot  was  tied  the 
same  day,  and  ever  since  then  he  has  been  the  happiest 
of  men.  Upon  the  whole  this  was  a  better  termination 
than  might  have  been  reasonably  expected. 

c.  Desire  ExtinguisJied  by  Perversion  of  the  Sexual 
Appetite.  It  sometimes  happens  that  the  perversion  of 
sexual  appetite  goes  much  further  than  it  did  in  the 
case  of  this  young  man,  and  that  infinitely  more  unnna- 
tural  and  degrading  acts  than  masturbation  take  the 
place  of  the  normal  physiological  function.  Such  cases 
have  received  a  considerable  amount  of  attention  from 
writers  on  medical  jurisprudence,  more  in  fact  than 
from  those  on  impotence,  though  they  are  worthy  of 
much  attention  in  this  relation. 

To  begin  with  the  most  common  example  of  the  con- 
dition in  question  and  which  is  more  a  vice  in  most 


30  SEXUAL   IMPOTENCE   IN   THE    MALE. 

instances  than  it  is  a  disease,  we  find  that  those  addicted 
to  pederasty  are  as  a  rule  devoid  of  desire  towards  the 
opposite  sex.  As  just  intimated,  the  practice  in  ques- 
tion is  generally  a  vice  resorted  to  b}^  debauchees  who 
have  exhausted  the  resources  of  the  normal  stimulus  to 
the  sexual  act  and  who  in  this  new  proceedure  find  for 
a  while  the  pleasure  which  they  can  no  longer  derive 
from  intercourse  with  women.  But  it  is  not  to  be  ques- 
tioned that  there  are  others  in  whom  it  assumes  more 
the  phase  of  a  disease  and  who  often  lament  the  ten- 
dencies to  which  they  are  subject,  and  which  they  are 
powerless  to  resist.  In  the  one  class  of  cases  there  is 
impotence  from  want  of  desire,  the  condition  having 
been  induced  by  the  acts  of  the  individual,  while  in  the 
other  there  is  a  like  condition  resulting  from  inherent 
perversion  of  the  sexual  instinct. 

Writing  on  this  subject,  Tardieu *  says:  "  I  do  not 
pretend  to  explain  that  which  is  incomprehensible, 
and  thus  to  penetrate  into  the  causes  of  pederasty.  We 
can  nevertheless  ask  if  there  is  not  something  else  in 
this  vice  than  a  moral  perversion,  than  one  of  the  forms 
of  psycJiopatliia  scxualis  of  which  Kaan  has  traced 
the  history.  Unbridled  debauchery,  exhausted  sensu- 
ality, can  alone  account  for  pederastic  habits  as  they 
exist  in  married  men,  and  fathers  of  families,  and  recon- 
cile with  the  desire  for  women  the  existence  of  these 
impulses  to  unnatural  acts.     We  can  form  some  idea  on 

*  "  Sur  les  attentats  aux  moeurs."  2™"  Edition.     Paris,  1858,  p.  125. 


ABSENCE   OF   SEXUAL   DESIRE.  31 

the  subject  from  a  perusal  of  the  writings  of  pederasts 
containing  the  expression  of  their  depraved  passions. 

"  Casper  has  had  in  his  possession  a  journal  in  which 
a  man,  member  of  an  old  family,  had  recorded,  day  by 
day,  and  for  several  years,  his  adventures,  his  passions, 
and  his  feelings.  In  this  diary  he  had,  with  unexampled 
cynicism,  avowed  his  shameful  habits,  which  had  ex- 
tended through  more  than  thirty  years,  and  which  had 
succeeded  to  an  ardent  love  for  the  other  sex.  He  had 
been  initiated  into  these  new  pleasures  by  a  procuress, 
and  the  description  which  he  gives  of  his  feelings  is 
startling  in  its  intensity.  The  pen  refuses  to  write  of 
the  orgies  depicted  in  this  journal,  or  to  repeat  the 
names  which  he  gave  to  the  objects  of  his  love.  .  .  . 

"  I  have  had  frequent  occasion  to  read  the  correspon- 
dence of  known  pederasts  and  have  found  them  apply- 
ing to  each  other,  under  the  forms  of  the  most  passion- 
ate language,  idealistic  names  which  legitimately  be- 
longed to  the  diction  of  the  truest  and  most  ardent 
love. 

"  But  it  is  difficult  not  to  admit  the  existence  in  some 
cases  of  a  real  pathological  alteration  of  the  moral  facul- 
ties. When  we  witness  the  profound  degradation,  the 
revolting  salacity  of  the  individuals,  who  seek  for  and 
admit  to  their  disgusting  favors  men  who  are  gifted  both 
with  education  and  fortune,  we  might  well  be  tempted 
to  think  that  their  sensations  and  reason  are  altered, 
but  we  can  entertain  no  doubt  on  the  subject,  when  we 
call  to   mind   facts  such  as  those  I  have  had  related  to 


32  SEXUAL   IMPOTENCE    IN   THE    MALE. 

me  by  a  magistrate,  who  has  displayed  both  ability  and 
energy  in  the  pursuit  of  pederasts.  One  of  these  men, 
who  had  fallen  from  a  high  position,  to  one  of  the  low- 
est depravity,  gathered  about  him  the  dirty  children  of 
the  streets,  knelt  before  them  and  kissed  their  feet  with 
passionate  submission  before  asking  them  to  yield  them- 
selves to  his  infamous  propositions.  Another  experi- 
enced singularly  voluptuous  sensations  by  having  a  vile 
wretch  administer  violent  kicks  on  his  gluteal  region. 
What  other  idea  can  we  entertain  of  such  horrors,  than 
that  those  guilty  of  them  are  actuated  by  the  most 
pitiable  and  shameful  insanity?" 

Cases  of  sexual  perversion  leading  to  indifference  to- 
ward the  other  sex  and  impotence  have  been  described 
by  Servaes,*  Kraft- Ebing,f  Liman,:|:  Le  Grand  du 
Saulle,§  Charcot  and  Magnan,|[  and  many  others.  Sev- 
eral instances  have  also  been  under  my  own  observation. 
While  it  is  not  necessary  to  refer  more  fully  to  the  dis- 
gusting details  of  all  these  cases,  the  description  of  some 
of  them  is  indispensable  to  the  thorough  consideration 
of  the  subject  under  discussion. 

Among   the   cases   of   undoubted  sexual    perversion 


*  "  Zur  Kenntniss  von  der  contriiren  Sexualempfindung. "  Archiv  ftir 
Psychiatric  und  Nervenkrankheiten,  1876,  p.  484. 

f  "  Ueber  gevvisse  Anomalien  des  Geschlechtstriebes,"  u.  s.  w.  Archiv 
ftir  Psychiatric,  1877,  p.  291. 

X  "Caspars  Lehrbuch,  6'°  Auflage,  p.  509. 

§  "  Les  signes  physiques  des  folies  raisonnantes"  (Discussion).  AniiaUs 
niedico-psychologiqucs ,  Mai  1 8 75,  p.  431  ct  scq. 

il  "'Inversion  du  sens  genital."  Archives  de  Neurologic,  No.  7,  1882, 
and  12,  1882. 


ABSENCE   OF   SEXUAL   DESIRE.  33 

which  have  been  reported,  is  an  interesting  one,  in 
which,  however,  the  condition,  though  undoubtedly 
existing,  was  not  recognized,  and  the  details  of  which 
have  been  given  by  Beck.*  The  instance  is  that  of 
Sprague,  who  was  tried  in  Brooklyn,  in  1849,  ^^^  high- 
way robbery,  said  to  have  been  committed  under  the 
following  circumstances:  He  was  a  printer  by  trade, 
and  one  morning  left  his  home  to  go  to  his  place  of 
business,  when  he  was  seen  to  rush  up  to  a  young  lady, 
throw  her  down,  and  then,  snatching  one  of  her  shoes, 
to  run  away.  Although  she  had  on  a  watch  and  chain 
and  other  articles  of  value,  he  did  not  attempt  to  take 
them,  nor  to  offer  any  other  violence  than  that  men- 
tioned. At  his  trial  the  defence  of  insanity  was  set  up. 
"  The  principal  witness  was  the  defendant's  father,  a 
clergyman  of  the  highest  respectability,  whose  testi- 
mony was  corroborated  in  every  particular  by  several 
other  witnesses,  indeed  by  all  the  court  thought  it 
worth  while  to  bring  forward.  Charles  Sprague  s paternal 
great-grandfather,  grandmother,  grcat-grand-tnicle,  and 
three  great  aunts,  being  four  out  of  a  family  of  six,  and  a 
cousijt,  are,  or  have  been,  insane.  He  had  himself,  in  youth, 
received  several  severe  blows  and  falls  upon  the  head,  and 
within  a  year  from  the  last  fall  he  began  to  suffer  headache, 
and  his  friends  observed  an  iinnatural  prominence  of  the 
eyes.  Simultaneously  with  this,  Sprague  began  to  ex- 
hibit a  propensity  to  abstract  and  conceal  the  shoes  of 
the  female  members  of  his  family.     In  the  majority  of 

*  "  Medical  Jurisprudence,"  vol.  i,  i860,  p.  732. 


34  SEXUAL   IMPOTENXE   IX   THE    MALE. 

instances  one  shoe  only  was  missed,  and  it  was  usually 
found  about  the  house,  having  been  thoroughly  sc^aked 
with  water,  twisted  up  like  a  rope,  and  then  hid  awav 
between  a  feather  and  straw  bed,  or  in  the  depths  of  a 
trunk,  or  hung  up  in  a  closet  with  garments  conceal- 
ing it. 

"  Suspicion  at  once  rested  upon  the  servants,  but  the 
real  agent  being  detected  and  questioned,  remained  si- 
lent, and  on  subsequent  explanations,  generally  denied 
the  possibility  of  his  agency  until  within  the  last  six 
years.  During  this  period,  when  remonstrated  with 
on  his  singular  habit,  he  would  admit  that  he  must  have 
taken  the  shoes,  though  he  had  no  recollection  of  it, 
and  did  not  know  for  what  he  wanted  them.  The  in- 
termissions  in  this  practice  have  at  no  time  exceeded 
three  or  four  months  at  one  time, 

"  After  the  practice  became  established,  Sprague's 
mother  and  sisters  and  the  female  servants  habitually 
locked  up  their  shoes  ;  yet,  occasionally  one  was  missed 
and  discovered  twisted  and  crumpled  after  being  wet. 
It  was  rumored  at  one  time  in  the  family  that  Sprague 
had  attempted  to  remove  the  shoe  from  the  foot  of  a 
domestic,  and  his  sister  alarmed  her  father  at  night  on 
finding  him  abstracting  her  shoes  from  a  locked  drawer. 
In  the  early  part  of  the  year  of  the  trial  two  females, 
one  residing  in  Brooklyn,  had  a  shoe  or  shoes  taken 
from  their  feet  while  walking  in  the  street  in  the  even- 
ing, but  the  offender  has  never  been  certainly  known." 

A  case  similar  to  this,  so  far  as  the  object  of   the 


ABSENCE   OF   SEXUAL   DESIRE.  35 

thefts  is  concerned,  has  lately  been  under  my  observa- 
tion, and  will  presently  be  more  fully  cited. 

Some  years  since,  in  the  city  of  Leipzig,  a  number  of 
young-  girls  were  assaulted  in  the  streets  by  a  man 
wrapped  in  a  cloak,  who  stuck  a  lancet  into  their  arms 
just  above  the  elbow  and  then  quickly  disappeared. 
Finally  he  was  discovered  and  arrested.  It  then  came 
out  that  he  had  been  actuated  by  a  morbid  sexual  im- 
pulse, that  the  incision  of  the  lancet  had  been  ac- 
companied by  a  seminal  emission,  and  that  his  whole 
existence  had  become  absorbed  in  the  alternate  excite- 
ment and  depression  which  preceded  and  succeeded  the 
act* 

In  the  discussion  to  which  reference  has  already  been 
made,  M.  Legrand  du  Saulle  gives  the  particulars  of  a 
case  which  he  had  a  short  time  previously  examined. 
The  patient  was  a  young  man  of  twenty  years  of  age,  a 
graduate  of  a  college,  of  an  aesthetic  turn  of  mind,  but 
of  a  cold  and  gloomy  disposition,  with  contemplative, 
misanthropic  and  spiteful  tendencies,  who  condemned 
himself  to  solitude,  who  fled  from  the  world  and  exhi- 
bited the  most  decided  repulsion,  not  only  towards 
women  in  general,  but  towards  al'.  that  could  exhibit  the 
least  evidence  of  a  feminine  origin,  or  of  the  intervention 
or  form  of  women.  He  felt  himself,  however,  on  the 
contrary,  irresistibly  drawn  towards  men  and  pictures, 

*  "  A  Treatise  on  Mental  Unsoundness,  Embracing  a  General  View 
of  Psychological  Law."  By  Francis  Wharton, LL.D.  Philadelphia,  1873. 
p.  600,  §  623. 


36        SEXUAL  IMPOTENCE  IN  THE  MALE. 

Statues,  and  images,  representing  man  in  a  naked  state 
He  possessed  anatomical  plates  depicting  the  genital 
organs  of  man,  the  adjuncts  to  virility,  and  he  was  con- 
stantly looking  out  for  a  chance  to  see  the  penis  of 
every  man  who  stopped  to  urinate  in  his  vicinity.  He 
was  one  day  arrested  in  a  public  urinal  in  the  Place  de 
la  Bourse,  where  he  and  an  old  man  were  standing 
looking  at  each  others'  genital  organs.  The  young 
man  was  the  son  of  a  h3-sterical  mother  ;  he  had  phi- 
mosis and  slight  atrophy  of  the  testicles.  For  the  for- 
mer a  surgical  operation  was  performed,  but  for  fear 
that  some  untoward  event  might  take  place,  a  statement 
of  his  condition  before  the  operation  was  drawn  up, 
dated  and  signed  by  M.  Legrand  du  Saulle  and  M.  Vi 
dal,  who  had  also  examined  the  patient,  in  which  it  was 
set  forth  that  the  case  was  one  of  the  most  abnormal 
genesic  perversion. 

The  following  case,  the  details  of  which  are  given  in 
the  patient's  own  words,  is  reported  by  MM.  Charcot 
and  Magnan.* 

"  My  sensual  feelings  were  manifested,"  he  said,  "from 
the  time  I  was  six  3'ears  old,  b}-  an  intense  desire  to 
see  boys  of  my  own  age,  or  men,  naked.  It  was  not 
difficult  for  me  to  satisfv  this  inclination,  for  m}^  parents 
lived  near  a  barrack,  and  the  soldiei"S  put  no  restraint 
on  the  exhibition  of  their  virile  organs.  One  day  I  saw 
(I  was  then  about  eight  vears  old)  a  soldier  masturbat- 

*  op.  cit..  No.  7,  p.  54. 


ABSENCE   OF   SEXUAL   DESIRE.  37 

ing.  I  imitated  him,  and  experienced  besides  tlie  pleas- 
ure of  the  imagination  as  to  what  the  soldier  was  doing, 
the  physical  pleasure  of  the  friction.  I  continued  to 
give  myself  pleasure  by  exciting  my  imagination  by  the 

remembrance  of  naked  men.     My  parents  left  N 

and  went  to  live  at  B ,  There  I  saw  that  the  sol- 
diers bathed  in  a  little  stream  and  in  a  completely  naked 
state.  I  resolved,  in  order  to  obtain  the  satisfaction  I 
wanted,  to  seat  myself  on  the  bank  of  the  river,  and  to 
pretend  to  sketch  the  landscape,  while,  without  appear- 
ing to  do  so,  I  could  look  at  them.  At  about  the  age 
of  fifteen,  puberty  was  attained,  and  I  derived  much 
more  satisfaction  from  my  acts  of  masturbation.  More- 
over, I  provoked  erection  and  its  results  as  much  by 
imagination  as  by  friction.  More  than  once  I  had  erec- 
tion, the  sexual  orgasm,  and  seminal  ejaculation  solely 
through  seeing  the  genital  organs  of  a  man.  At  night 
my  imagination  was  excited  and  the  like  results  ensued. 
At  the  age  of  twenty  I  stopped  masturbating,  but  I  was 
never  able,  notwithstanding  all  my  efforts,  to  control 
the  excitation  of  my  imagination.  Strong,  handsome, 
and  young  men  always  provoked  in  me  a  strong  emo- 
tion ;  a  fine  statue  ot  a  naked  man  also  caused  a  like 
effect.  The  Apollo  Belvidere  excited  me  greatly. 
When  I  met  a  man  whose  youth  and  beauty  excited  my 
passion,  I  was  tempted  to  please  him,  and  if  1  had  given 
a  free  rein  to  my  feelings  I  would  have  shown  him  all 
possible  kindnesses  ;  I  would  have  invited  him  to  my 
house,  and  written  to  him  on  perfumed  paper.     I  would 


38  SEXUAL   IMPOTENCE   IN   THE    MALE. 

have  sent  him  flowers  and  made  him  presents,  and  I 
would  have  deprived  myself  of  many  things  in  order 
that  I  might  have  rendered  myself  agreeable  to  him.  I 
never  did  these  things,  but  I  was  quite  sure  I  was  capa- 
ble of  doing  them.  I  thought  by  refraining  I  might 
conquer  the  desires  I  experienced.  I  knew  how  to 
overcome  the  inclinations  of  which  1  speak,  but  I  was 
never  able  to  subdue  the  love  I  felt.  Fortunately  for 
me  my  love  was  changeable.  Work  and  my  studies 
are  a  great  assistance  to  me  against  my  venereal 
thoughts,  but  often  sensuahty  prevails,  and  I  am  obliged 
to  stop  in  the  midst  of  the  studv  of  an  intricate  question 
by  the  sudden  appearance  of  a  naketi  man  in  my  imagi- 
nation. I  have  always  fought  as  hard  as  I  could  against 
this  sensuality,  and  I  have  often  refrained  from  acts 
towards  which  I  felt  myself  impelled,  but  I  have  never 
been  able  to  extinguish  the  sensuality  itself.  The  su- 
preme satisfaction  of  this  sensuality  has  never  extended 
beyond  the  sight  of  a  naked  man,  and  especiall}^  the 
penis  of  a  man,  and  I  have  never  felt  any  inclination  to 
enter  a  man  or  to  be  the  passive  object  of  a  man.  To 
see  the  genital  organs  of  a  strong  and  handsome  man 
has  always  caused  in  me  the  highest  voluptuous  feel- 
ings. 

"  As  to  women,  however  beautiful  they  may  be,  they 
never  excite  in  me  the  least  desire.  I  have  tried  to 
love  one,  believing  thus  to  turn  my  ideas  into  their  nat- 
ural channel,  but  notwithstanding  her  beauty  and  her 
assistance  I  have  remained  entirely  unmoved,  and  ercc- 


ABSENCE   OF   SEXUAL   DESIRE.  39 

tion,  SO  easy  with  me  at  the  sight  of  a  man,  has  never 
even  had  a  beginning.  No  woman  has  ever  provoked 
in  me  the  slightest  sexual  feeling. 

"  I  admire  the  feminine  toilet ;  I  love  to  see  a  woman 
well  dressed,  for  I  am  then  reminded  that  if  I  should 
be  a  woman  I  would  dress  in  that  way.  At  the  age  of 
seventeen  1  dressed  myself  like  a  woman  at  a  carnival, 
and  I  experienced  an  indescrib"':)le  pleasure  trailing 
my  skirts  on  the  floor,  in  arranging  my  false  hair,  and 
in  putting  on  my  low-necked  dress.  Until  I  had 
reached  my  twenty-second  year  I  took  the  greatest 
pleasure  in  dressing  a  doll,  and  it  affords  me  much 
pleasure  even  now. 

"  Ladies  are  astonished  to  find  that  I  am  as  good  a 
judge  of  the  good  or  bad  taste  of  their  toilets,  and  at 
hearing  me  talk  of  things  as  if  I  were  myself  a  woman. 

"  The  love  which  I  may  feel  for  any  particular  wo- 
man passes  quickly,  for  as  another  handsomer  in  my 
eyes  makes  her  appearance  the  thought  of  the  first  dis- 
appears. 

"  For  the  last  few  months  nocturnal  emissions  are 
not  so  frequent  with  me  as  they  used  to  be.  At  pres- 
ent three  weeks  have  elapsed  since  I  have  had  one,  but 
I  continue  to  have  my  usual  dreams  and  to  desire 
always  to  see  (nothing  more)  naked  men." 

MM.  Charcot  and  Magnan  give  a  good  many  other 
particulars  in  regard  to  this  interesting  case,  some  of 
which  are  of  great  importance  from  a  neurological 
point  of  view,  but  which  have   no  very  direct  bearing 


40        SEXUAL  IMPOTKNCE  IN  THE  MALE. 

on  the  point  at  issue.  He  was  advised  to  make  the 
intellectual  effort  of  substituting  a  woman  for  a  man  in 
the  crises  to  which  he  was  subject.  He  made  many 
efforts  in  this  direction,  but  his  mind  constantly  turned 
to  a  naked  man.  Finally,  however,  after  several 
months'  contest  he  succeeded  to  some  extent,  and  even 
went  so  far  as  to  establish  sexual  relations  ^\ith  a  wo- 
man, from  which  he  derived  voluptuous  sensations. 
The  moral  effect  was  excellent,  and  for  several  days  he 
had  some  repose  from  his  former  sensations.  Being 
obliged,  however,  to  quit  Paris  for  a  time,  and  then 
being  forced  to  fight  his  former  inclinations  with  his 
reason  alone,  he  began  to  feel  his  unnatural  proclivi- 
ties again  obtaining  the  ascendancy. 

In  this  case,  in  addition  to  the  moral  treatment,  re- 
course was  had  to  hydrotherapv  (cold  affusions  and 
douching)  and  to  the  administration  of  the  bromide  of 
potassium,  which,  it  is  said,  diminished  the  intensity 
and  duration  of  his  desires  without  lessening  their  fre- 
quency. 

The  principal  points  of  interest  in  the  present  con- 
nection which  this  case  presents  are  the  sexual  excite- 
ment and  ejaculation  of  semen  produced  by  the  sight 
of  a  naked  man,  a  penis,  or  even  of  a  nude  statue,  while 
at  the  same  time  there  is  absolute  frigidity  as  regards 
woman.  It  is  a  true  instance  of  sexual  perversion,  and 
of  consequent  impotence  so  far  as  concerns  the  female 
sex. 

In  another  case,  reported  at  great  length   h}-  MM. 


ABSENCE   OF   SEXUAL   DESIRE.  41 

Charcot  and  Magnan,  the  subject  had  the  sexual  or- 
gasm by  thinking  of  the  nails  in  women's  shoes.  It 
does  not  appear,  however,  that  he  was  impotent  as 
regards  physiological  sexual  relations. 

But  in  the  following  curious  case  there  was  a  tempo- 
rary state  of  impotence,  and  I  therefore  relate  it  as  of 
interest  in  the  present  discussion. 

The  patient  was  thirty-seven  years  of  age  and  of  good 
constitution,  but  came  of  an  eccentric  family.  He  was 
studious,  but  learned  with  difficulty  what  he  studied. 
He  changed  his  occupation  frequently,  and  would  de- 
prive himself  of  necessaries  in  order  to  purchase  books 
and  other  articles  to  which  he  took  a  fancy. 

At  the  age  of  five  years,  having  been  sleeping  for 
several  months  with  a  female  relative  thirty  years  old, 
he  experienced  for  the  first  time  a  singular  phenome- 
non, which  was  no  less  than  a  genital  excitement  and 
an  erection  when  he  saw  his  bedfellow  put  on  her  night- 
cap. At  about  the  same  time  he  had  occasion  to  see 
an  old  servant  woman  undress  herself  and  put  on  her 
night-cap,  and  at  once  sexual  excitement  and  an  erec- 
tion were  produced.  Later,  the  very  idea  of  an  old 
and  wrinkled  woman  arrayed  in  a  night-cap  was  suf- 
ficient to  provoke  the  sexual  orgasm.  The  sight  of  a 
night-cap  by  itself  caused  no  disturbance,  but  contact 
with  one  caused  erection  and  sometimes  an  emission. 
On  the  other  hand  he  remembered  that  he  had  re- 
mained, at  about  his  seventh  year,  absolutely  irrespon- 
sive to  attempts  at  masturbation  made  upon  him  by 


42  SEXUAL   IMPOTENCE   IN   THE    MALE. 

one  of  his  school-fellows.  He  had  never  sought  any 
abnormal  relations,  and  the  sight  of  a  naked  man  or 
woman  had  no  effect  upon  him.  Up  to  his  twenty-sec- 
ond year,  at  which  time  he  was  married,  he  had  never 
had  sexual  intercourse.  He  had  married  a  woman 
twenty -five  years  old,  pretty,  and  for  whom  he  enter- 
tained a  real  affection.  The  first  night  of  his  marriage 
he  remained  impotent  by  the  side  of  his  young  wife. 
On  the  second  night  the  same  condition  existed,  when, 
becoming  desperate,  he  called  up  in  his  imagination 
the  old  wrinkled  woman  with  her  night-cap.  The  re- 
sult was  immediate,  and  he  performed  his  marital  du- 
ties effectively.  During  the  next  five  years  of  married 
life  he  was  forced  to  avail  himself  of  this  expedient,  as 
he  remained  impotent  till  he  recalled  the  image  of  the 
old  woman  and  her  night-cap.  He  deplored  this  sin- 
gular situation,  regarding  it  as  a  sort  of  profanation 
of  his  wife,  but  he  does  not  appear  to  have  been  able 
to  alter  it.  Other  symptoms  of  deranged  cerebral  ac- 
tion supervened. 

In  another  case,  cited  by  the  same  authors,  the  sub- 
ject, who  was  of  an  insane  ancestry  and  was  himself 
of  a  strong  neurotic  temperament,  was  compelled  to 
masturbate  whenever  he  saw  a  white  apron.  He  be- 
came so  infatuated  with  white  aprons  that  the  thought 
of  one  was  sufficient  to  cause  the  sexual  orgasm.  Final- 
ly he  took  to  stealing  them,  and  was  repeatedlv  ar- 
rested for  thefts  of  these  articles  of  dress.  He  entered 
a  convent  in  order  to  prevent  himself  yielding  to  his 


ABSENCE   OF   SEXUAL   DESIRE.  43 

impulses,  but  after  staying-  there  three  years  his  relig- 
ious zeal  flagged ;  he  came  out  and  at  once  began  his 
old  habits.  A  search  was  made  of  his  premises,  and  a 
collection  of  white  aprons,  spotted  with  seminal  stains, 
was  found.  He  was  then  examined,  and  being  found 
to  be  of  unsound  mind,  was  placed  in  a  lunatic  asy- 
lum. 

After  about  a  year  he  was  discharged,  and  then  had 
ideas  of  suicide,  and  became  melancholic.  He  stopped 
stealing  white  aprons  and  formed  relations  with  a 
woman.  He  was  unable,  however,  to  have  intercourse 
with  her  unless  he  called  to  mind  at  the  time  the 
appearance  of  a  white  apron,  just  as  he  had  formerly 
done  when  he  practised  onanism. 

Cases  in  which  the  individual  has  the  delusion  that 
his  or  her  sex  is  changed,  are  not  to  be  confounded 
with  those  now  under  consideration.  The  first  are 
veritable  cases  of  intellectual  monomania,  and  are  not 
usually  accompanied  by  any  aberrant  manifestations  of 
the  sexual  appetite.  I  have  considered  them  in  another 
work,*  and  pointed  out  their  characteristics,  chief 
among  which  is  their  excessive  modesty  and  decorous 
bearing,  so  far  as  the  genesic  function  is  concerned. 
The  other  class,  in  which  the  individuals,  knowing 
themselves  to  be  men  or  women,  assume  the  dress  and 
imitate,  as  far  as  they  can,  the  manners  and  actions  of 
the  opposite  sex,   I   have    also  alluded  to  in  another 


*  "  A  Treatise  on  Insanity  in  its  Medical  Relations,"  New  York,  1S83, 


44  SEXUAL   IMPOTENCE   IX   THE    MALE. 

work,^  but  propose  to  consider  it  at  still  further  length, 
as  well  as  some  other  phases  of  aberration,  by  giving 
the  details  of  instances  which  have  come  under  my 
own  observation. 

A  case  presenting  some  analogies  with  that  already 
given  of  the  young  man  who  had  a  penchant  for  steal- 
ing women's  shoes,  was  several  years  since  under  m}' 
care,  and  led  me  to  the  conclusion  that  in  the  one 
referred  to  there  was  also  an  aberrant  sexual  feeling  as 
the  basis  of  the  acts. 

The  patient,  a  man  somewhere  about  twenty-four 
years  of  age,  was  a  member  of  a  highly  neurotic 
family.  One  uncle  on  his  mother's  side  had  died  in  an 
asylum,  and  his  grandfather  on  his  father's  side  had 
also  died  insane.  One  sister  was  subject  to  epilepsy 
and  another  to  severe  attacks  of  migraine.  His  father 
and  mother,  though  both  very  excitable  and  impres- 
sionable, were,  as  far  as  known,  free  from  disease. 
While  cutting  his  teeth  he  had  had  two  or  three  con- 
vulsions, but  had  passed  through  the  period  of  dentition 
without  further  trouble. 

When  about  seven  years  of  age,  a  woman  emplo3'ed 
in  the  family  as  a  servant  taught  him  masturbation,  and 
endeavored  very  frequently  to  cause  him  to  have  sexual 
intercourse  with  her.  Upon  one  occasion  she  had 
practised  friction  on  his  penis  with  her  foot  without 
taking  off  her  shoe,  and  this  was  the  first  time  he  had 

*  "The  Diseases  of  the  Scythians  (Morbus  Foeminarum),  and  Certain 
Anagolous  Conditions,"  American  Journal  of  Neurology  and  Psychiatry. 


ABSENCE    OF   SEXUAL   DESIRE.  45 

derived  any  pleasure  from  her  manoeuvres.  But  from 
that  time  on,  the  sight  of  a  woman's  shoe  caused  sexual 
excitement  and  erections,  and  in  a  short  time  the  mere 
idea  of  the  object  was  sufficient  for  the  purpose  in 
question.  After  a  time,  however,  when  he  had  learned 
masturbation,  he  used  to  practice  the  act,  while  his 
whole  mind  was  fixed  on  images  of  women's  shoes  of 
all  kinds,  and  in  all  positions  about  him.  There  was 
scarcely  a  night,  after  he  became  eight  or  nine  years  of 
dge,  that  he  did  not  bring  about  the  sexual  orgasm  by 
mental  concentration.  His  school  teacher  was  a 
woman,  and  while  at  school  he  was  constantly  en- 
deavoring to  get  a  look  at  her  shoes  and  thus  procure 
for  himself  sexual  pleasure.  Girls  attended  the  school, 
but  their  shoes  did  not  have  the  effect  upon  him  that 
those  of  a  woman  did.  It  appeared,  too,  that  the  fact 
that  the  shoes  were  concealed  by  the  long  dress  worn 
bv  a  woman  had  something  to  do  with  the  effect  upon 
his  sexual  feelings. 

One  day,  while  at  school,  and  the  teacher  was  sitting 
on  a  raised  platform  at  the  farther  end  of  the  room,  the 
idea  occurred  to  him  that  his  sexual  pleasure  would  be 
greater  if  he  could  hold  one  of  her  shoes  in  his  hand  for 
a  moment.  He  acted  on  the  idea  at  once,  and  going  to 
where  his  teacher  was  seated,  fell  down  on  his  knees, 
seized  one  of  her  shoes,  and  at  once  experienced  greater 
pleasure  than  he  had  yet  felt.  At  the  moment  of  touch- 
ing it  the  orgasm  began.  For  this  act,  which  was  not 
understood,  but  was  supposed  to  be  a  kind  of  insubor- 


46  SEXUAL   IMPOTENCE   IN   THE   MALE. 

dination,  he  was  severely  punished.  This  did  not  deter 
him,  however,  from  repeating  the  performance  the  next 
day,  with  a  like  result,  both  as  regards  the  orgasm  and 
the  flogging.  He  did  not  care  for  the  latter.  On  the 
contrary,  it  prolonged  his  pleasure. 

But  ere  long  the  fact  was  recognized  that  something 
was  wrong  with  him,  and  the  teacher  laid  the  matter 
before  his  parents.  When  asked  why  he  had  acted  in 
such  a  disorderly  manner  at  school,  he  simply  replied 
that  he  could  not  help  it,  but  gave  no  further  explana- 
tion of  his  conduct.  The  result  was,  that  he  was 
removed  from  that  school  and  sent  to  another  kept  by 
a  man. 

Although  the  material  means  of  excitement  were 
removed,  he  formed  mental  images  of  the  other  school, 
of  the  teacher  at  the  end  of  the  room,  and  of  his  going 
down  on  his  knees,  seizing  her  shoe  and  experiencing 
the  sexual  .orgasm.  The  remembrance  was  generally, 
though  not  always,  sufficient  to  cause  excitement, 
erections,  and  sometimes  the  orgasm.  He  had  fre- 
quently, when  the  excitement  had  been  high  and  es- 
pecially when  he  seized  one  of  his  teacher's  shoes,  had 
emissions,  but  at  about  his  fourteenth  year  they  gener- 
ally,  though  not  always,  occurred  during  the  orgasm. 
To  produce  this,  he  had  only  to  practice  friction  of  the 
glans,  while  he  thought  of  a  woman's  shoe ;  but  about 
this  time  the  idea  was  conceived,  that  if  he  used  such 
an  object  for  masturbatory  purposes,  the  pleasure 
would  be  increased.       He  therefore  took  a  shoe  sur- 


ABSENCE   OF   SEXUAL   DESIRE  47 

reptitiously  from  a  drawer  in  which  one  of  the  female 
servants  kept  her  clothing-,  and  made  use  of  it  in  the 
manner  which  had  suggested  itself  to  him. 

This  act  gave  him  greater  pleasure  than  any  which 
he  had  yet  performed,  and,  thereafter,  formed  his  only 
method  of  producing  the  sexual  orgasm.  Then  he 
varied  the  enjoyment,  and  at  the  same  time  augmented 
it,  by  using  a  different  shoe  each  time.  To  get  them, 
he  had  to  resort  to  theft,  but,  generally,  he  returned 
them  to  their  proper  places,  after  they  had  served  his 
purpose.  Some  young  female  friends  of  his  sisters, 
who  were  at  the  time  paying  them  a  visit,  unknow- 
ingly contributed  to  his  libidinous  desires,  by  his  taking 
their  shoes,  which  he  often  did  at  night,  by  entering 
their  room  while  they  were  asleep. 

In  all  this  time,  he  had  never  experienced  the  least 
sexual  excitement,  by  thoughts  of  women,  or  by  the 
sight  of  them,  in  a  greater  or  less  approach  to  complete 
nudity.  Pictures  of  naked  women,  of  their  genital 
organs,  or  of  men  and  women  in  the  act  of  sexual  inter- 
course, such,  as  in  some  schools,  pass  from  boy  to  boy, 
never  gave  him  any  other  feeling  than  one  of  intense 
disgust.  It  never  occurred  to  him  to  think  of  the  act 
of  sexual  intercourse,  and  no  woman  had  ever  caused 
him  the  slightest  degree  of  amorous  feeling.  Nothing 
roused  in  him  any  sexual  sensations,  but  the  thought, 
the  sight,  or  the  use,  of  a  woman's  shoe. 

When  about  eighteen  years  of  age,  he  began  a  shop- 
keeping   business    in  a  small  town,  and   among  other 


48        SEXUAL  IMPOTENCE  IN  THE  MALE. 

things  kept  women's  shoes  for  sale.  Here  he  derived 
great  pleasure  from  fitting  shoes  on  the  women  who 
patronized  him,  and  in  handling  the  shoes  they  had 
worn.  Often  he  would  experience  the  sexual  orgasm 
while  thus  engaged,  but  nothing  gave  such  intensely 
voluptuous  sensations  as  the  use  of  the  shoe  in  mastur- 
bation. 

Strange  as  it  may  seem,  he  had,  as  yet,  no  idea  that 
he  was  doing  anything  specially  degrading  or  wrong 
in  acting  as  he  did,  or  that  he  was  injuring  his  health ; 
but,  shortly  after  going  into  business,  and  while  fitting 
a  shoe  on  a  young  woman,  during  which  he  had  a 
strong  erection,  but  no  orgasm,  he  suddenly  lost  con- 
sciousness, and  had  a  severe  epileptic  paroxj-sm. 

A  few  days  afterward,  while  engaged  in  masturba- 
ting in  his  usual  manner,  he  had,  immediately  after  the 
orgasm,  another  seizure,  much  more  severe  than  the 
first,  during  which  he  bit  his  tongue  severel}-.  and 
bruised  his  face  in  falling,  so  that  he  was  marked  for 
several  days.  Becoming  seriously  alarmed,  he  deter- 
mined to  make  ever}-  effort  to  stop  his  disgusting 
practices.  This  was  hard  work  at  first,  and  there  were 
many  relapses,  but,  finally,  he  succeeded  to  such  an 
extent  that  he  would  go  several  weeks — on  one  oc- 
casion four  months — without  ever  masturbating.  He 
never,  however,  was  able  to  prevent  sexual  excitement 
and  erections  at  the  sight  of  a  woman's  shoe,  or  the 
thought  of  it.  He  gave  up  fitting  women  with  shoes ; 
but,  whenever  one  came  into  his  shop  to  look  at  shoes 


ABSENCE   OF   SEXUAL   DESIRE.  49 

he  experienced  the  usual  manifestations  of  the  idea.  At 
last  he  gave  up  this  department  of  his  business,  and 
began  to  turn  his  attention  still  more  strenuously  to 
the  purpose  of  getting  rid  of  the  association,  in  his 
mind,  between  women's  shoes  and  the  genesic  func- 
tion. 

But  now  a  new  phenomenon  made  its  appearance. 
He  had  never,  to  his  knowledge,  had  a  nocturual  emis- 
sion ;  probably  owing  to  the  fact  that  he  had  practised 
masturbation  so  often  that  there  was  no  excitability 
to  be  provoked.  Occasionally,  he  had  dreamed  of 
women's  shoes,  but  the  dream  had,  so  far  as  he  knew, 
never  produced  an  emission.  Now,  however,  with  the 
stoppage  of  the  voluntary  excitations,  a  change  in  this 
respect  had  ensued,  and  almost  every  night  he  had 
vivid  dreams  of  the  exciting  objects,  accompanied  by 
ejaculations  of  semen.  He  therefore  reached  the  con- 
clusion that  his  efforts  had  all  come  to  naught,  and  he 
was  strengthened  in  this  conviction  by  the  fact  that 
he  had  had  several  nocturual  epileptic  convulsions ;  at 
least,  so  he  supposed,  and  there  could  be  no  doubt 
about  the  matter,  from  the  fact  that  several  times,  on 
awakening,  he  had  found  his  tongue  sore  from  the 
wounds  he  had  given  it  with  his  teeth,  and  blood- 
stained spots  on  the  pillow. 

Although,  as  I  have  said,  he  had  never  had  the  slight- 
est sexual  feeling  towards  women,  or  even  associated 
with  them,  he  determined  to  marry,  in  the  hope  that, 
by  this  means,  he  might  be  cured  of  his  troubles.     He 


50        SEXUAL  IMPOTENCE  IN  THE  MALE. 

accordingly,  after  a  shori  acquaintance,  made  matrimo 
nial  proposals  to  a  young  woman  of  attractive  appear- 
ance, and  shortly  afterwards  was  married.  He  found, 
however,  to  his  dismay,  that  he  was  impotent,  so  far 
as  regarded  normal  physiological  intercourse.  If  he 
thought  of  his  wife's  shoes  he  had  an  erection,  but  as 
soon  as  he  made  the  attempt  at  intercourse  the  penis  be- 
came flaccid  and  entrance  was  impossible.  A  whole 
week  was  passed,  night  after  night,  in  fruitless  attempts 
to  consummate  the  marriage,  and  then  he  decided  to 
obtain  medical  advice.  He  came  to  me,  and,  with  great 
frankness,  gave  me  the  full  history  of  his  case,  as  I  have 
stated  it. 

Upon  examination  I  found  the  genital  organs  well 
formed  and  in  every  respect  natural.  He  stated  that 
every  night  since  his  marriage  he  had  had  a  nocturnal 
emission,  but  that  at  every  attempt  to  effect  entrance 
the  erection,  however  strong,  had  at  once  gone  down, 
and  he  had  failed.  On  two  occasions  emissions  had 
occurred  through  the  efTect  of  his  imagination  and  be- 
fore he  could  place  himself  in  position,  but  they  were 
from  thoughts  of  women's  shoes,  and  not  from  anv  nat- 
ural ex'citation.  The  very  idea  of  sexual  intercourse  or 
even  of  sleeping  in  the  same  bed  with  a  woman  was  un- 
pleasant, and  no  blandishment  of  his  wife  had  the  slight- 
est effect  in  causing  desire,  unless  he  thought  of  the 
usual  objects.  Then  erection  occurred,  but  the  diver- 
sion of  the  thoughts  in  another  direction  at  once  led  to 
its  dissipation.     B}^  no  effort  of  his  will  could  he  con- 


ABSENCE   OF   SEXUAL   DESIRE.  5 1 

tinue  to  think  of  the  shoes  and  of  the  act  to  be  per 
formed  at  the  same  time. 

I  suggested  to  him  that  he  should  hang  one  of  his 
wife's  shoes  at  the  head  of  the  bed  and  keep  it  in  sight 
while  he  made  the  effort  at  intercourse  and  continue  to 
do  so  till  he  had  become  habituated  to  his  new  relation. 
I  also  advised  that  he  should  keep  his  thoughts  as  much 
on  his  wife  and  to  try  to  imagine  her  conversion  into  a 
woman's  shoe.  At  the  same  time  I  prescribed  the  bro- 
mide of  sodium,  to  be  taken  in  doses  of  fifteen  grains, 
three  times  a  day.  I  gave  this  as  much  for  the  relief  of 
his  epileptic  condition  as  for  anything  else,  though  I 
was  not  unmindful  of  its  power  to  lessen  erethism  of 
the  sexual  organs  as  well  as  of  the  brain.  With  instruc- 
tions to  continue  this  plan  of  treatment  for  ten  days  and 
then  to  return  to  me  for  further  observation,  I  dismissed 
him. 

At  the  expiration  of  the  period  named  he  again  pre- 
sented himself,  and  I  knew  as  soon  as  I  saw  his  face  that 
there  was  some  success.  In  the  first  place,  he  had  had 
no  epileptic  attack,  and  in  the  next,  and  what  he  con- 
sidered the  most  important,  he  had  twice  succeeded  in 
having  intercourse.  He  had  gone  somewhat  farther 
than  I  had  advised,  and  had  taken  his  wife  into  his  con- 
fidence relative  to  the  influence  of  women's  shoes  in 
causing  sexual  excitement  and  erections.  I  scarcely 
believe  he  told  her  the  whole  story,  but  he  revealed 
enough  to  excite  her  sympathy  and  to  procure  her  as- 
sistance, and  the  result  was  as  I  have  stated.      After 


52  SEXUAL   IMPOTENCE    IN   THE   MALE. 

this  he  had  very  little  trouble,  though  occasionally  he 
would  fail.  His  wife  became  pregnant,  but  the  child 
was  still-born  at  the  eighth  month.  There  has  been  no 
subsequent  pregnancy,  though  he  tells  me  he  has  inter- 
course about  once  in  ten  days.  He  still  has  to  think  of 
women's  shoes,  but  is  confident  that  he  is  growing  in- 
different to  that  species  of  sexual  excitation.  He  is 
still  obliged  to  take  the  bromide  for  his  epilepsy,  though 
a  nightly  dose  of  thirty  grains  suffices  to  prevent  the 
attacks.  If  he  stops  for  longer  than  a  week  he  is  certain 
to  have  a  paroxysm.  He  will,  probably,  have  to  take  it 
during  the  rest  of  his  life. 

The  foregoing  is  certainly  a  very  remarkable  case,  for 
it  shows  not  only  the  perversity  of  some  natures  as  re- 
gards the  sexual  passion,  but  it  also  exhibits  how  much 
may  be  done  by  intense  mental  effort,  even  by  a  person 
not  of  very  strong  intellectual  development  in  bringing 
matters  back  to  a  normal  channel. 

Dr.  Cox,  ^  of  Colorado,  gives  the  particulars  of  a 
case  which,  though  not  so  remarkable  as  the  one  I 
have  just  described,  is  nevertheless  sufficiently  interest- 
ing, not  only  in  its  genesic,  but  in  its  psychological 
relations.     I  cite  it  in  his  own  lansfuasfe. 

"  This  man  has  a  wife  and  several  beautiful  children, 
and  within  the  sanctity  of  his  home,  where  he  is  al- 
ways to  be  found  during  the  evening,  his  precept  and 
example  are  so  noble  and  pure  and  good,  that  his  in-* 

*"  Transactions  of  the  Colorado   State  Medical  Society" — quoted  in 
The  Alienist  and  N^eurologist,  April,  1883,  p.  345. 


ABSENCE   OF   SEXUAL   DESIRE.  53 

fluence  is  felt  and  praised  by  all  of  his  many  friends 
and  admirers.  But  at  stated  periods,  away  from  home, 
he  is  a  holy  terror  to  the  biblical  standard  of  those  who 
have  the  promise  of  seeing  God,  an  angel  of  mercy  to 
the  fast  women  whom  he  patronizes,  and  an  insoluble 
enigma  to  all  mankind. 

"  He  has  never  been  known  to  cohabit  with  a  lewd 
woman,  or  to  speak  an  immodest  word  ;  but  he  is  a 
regular  visitor,  and,  in  his  peculiar  way,  a  liberal 
customer  at  certain  houses  of  ill  repute.  His  custom 
is  to  go  early  in  the  afternoon,  select  two  or  three  of 
the  largest  girls  in  the  house,  and  repair  to  a  private 
room  and  lock  the  door.  Here  he  divests  himself  of 
every  stitch  of  clothing,  from  the  waist  upwards,  but 
never  removes  his  trowsers  or  boots.  Then,  lying 
prostrate  upon  the  floor,  with  his  hands  lightly  crossed 
over  the  abdomen  and  his  eyes  tightly  closed,  he  com- 
mands his  companions  to  walk  over  his  naked  chest, 
neck  and  face,  taking  care  to  stop  at  each  step  to 
grind  his  flesh  with  the  heels  of  their  boots.  After  this 
process  has  continued  for  some  time,  he  begins  to  buy 
the  wine  for  the  girls  to  drink,  but  religiousl}''  abstains 
from  taking  a  drop  himself. 

"About  the  only  noticeable  interest  he  takes  in  the 
proceeding  is  an  occasional  demand  for  a  heavier  girl, 
or  for  some  means  by  which  they  can  increase  the 
severity  of  the  punishment.  The  tramping  process 
goes  on  uninterruptedly  for  two  or  three  hours,  at  the 
end  of  which  time  he  will  have  ordered  a  dozen  or 


54        SEXUAL  IMPOTENCE  IN  THE  MALE. 

more  bottles  of  wine,  besides  paying  the  fair  trampers 
handsomely  for  their  time  and  trouble. 

"One  of  his  diversions  is  to  make  one  of  the  girls 
stand  on  his  chest  with  her  entire  weight  on  one  boot- 
heel,  and  have  the  other  girls  spin  her  around  till  his 
flesh  is  torn  and  bleeding.  He  will  also  frequently 
direct  a  girl  to  place  one  foot  across  his  eyes,  with  the 
boot-heel  resting  in  one  orbit  and  the  other  foot  across 
his  throat.  He  will  keep  her  in  this  position  for  five  or 
ten  minutes,  thus  sustaining  a  weight  of  one  hundred 
and  fifty  pounds  or  more.  It  would  be  impossible  to 
mention  all  the  means  of  torture  that  this  man  has  in- 
vented and  submitted  to,  but  1  merely  mention  these 
few  facts  as  being  samples  of  dozens  which  I  have 
heard  of. 

"At  the  conclusion  of  one  of  these  matinees,  our 
hero  puts  himself  through  a  course  of  rubbing  his 
injured  spots  with  his  naked  hands ;  and  a  very  strange 
part  of  the  story  is  the  fact  that  by  this  simple  process 
his  bruises,  scars  and  ecchymoses  will  almost  entirely 
disappear  within  a  very  few  minutes. 

"  Having  thus  rubbed  himself  back  to  a  state  of  pre- 
sentability,  he  resumes  his  clothing,  pays  his  bill,  and 
takes  himself  off  to  the  marts  of  trade,  but  only  to 
return  and  repeat  the  strange  entertainment  in  about  a 
week." 

The  ratio7iale  of  such  a  case  would  be  difficult  to  dis- 
cover, were  it  not  for  our  acquaintance  with  similar 
instances,  which  teach  us  that  by  analogous  methods 


ABSENCE   OF   SEXUAL   DESIRE.  55 

some  men  procure  a  species  of  venereal  excitement, 
perhaps  of  a  more  exalted  character  than  that  to  be  ob- 
tained by  the  physiological  and  normal  process  of 
sexual  intercourse.  The  fact,  however,  that  this  in- 
dividual had  children,  shows  that  he  was,  at  one  time 
at  least,  not  incapable  of  copulation.  It  would  be  in- 
teresting to  know  how  long  he  has  been  addicted  to 
the  practice  described  by  Dr.  Cox,  and  also  the  age  of 
his  youngest  child.  I  am  of  the  opinion  that  he  is  im- 
potent with  women,  and  that  his  only  means  of  obtain- 
ing the  sexual  orgasm  is  by  subjecting  himself  to  the 
treatment  mentioned.  There  are  men,  or  at  least  in- 
dividuals in  the  image  of  man,  who  never  experience 
the  orgasm  unless  it  is  excited  by  acts  of  cruelty  and 
bloodshed,  either  performed  upon  others  or  upon  them- 
selves. It  appears  to  me  that  the  subject  of  Dr.  Cox's 
communication  is  one  of  these,  and  that  while  he  is 
being  bruised  and  mangled  he  is  experiencing  intense 
sexual  pleasure,  with  repeated  acts  of  seminal  ejacula- 
tion. 

Several  cases  of  sexual  inversion  in  which  the  subjects 
were  disposed  to  form  amator}^  attachments  to  other 
men,  have  been  under  my  observation.  They  are  even 
more  distressing  and  disgusting  than  cases  such  as  that 
the  details  of  which  I  have  just  given  ;  but  it  is  neces- 
sary for  the  elucidation  of  the  subject  to  bring  their  de- 
tails before  the  practitioner.  So  long  as  human  nature 
exists  such  instances  will  occur  and  physicians  must  be 
prepared  to  treat  them. 


56        SEXUAL  IMPOTENCE  IN  THE  MALE. 

One  of  these  was  a  young  man,  a  cigar-dealer  of  this 
city,  who,  from  a  very  early  period  of  his  hfe  had  con- 
tracted the  habit  of  introducing  substances  into  the 
anus  for  the  purpose  of  having  sexual  pleasure.  He 
had  been  led  to  the  practice  by  seeing,  while  yet  a  very 
young  child,  a  dog  coupled  with  a  bitch,  and  supposing 
that  the  connection  was  by  the  anus,  he  had  inserted  a 
wooden  lead  pencil  into  the  corresponding  opening  of 
his  own  body.  This  had  caused  him  some  local  pain 
but  it  had  also  produced  a  singular  but  voluptuous  sen- 
sation  the  exact  location  of  which  he  was  then  not  able 
to  fix. 

At  this  time  he  was  about  seven  years  old.  In  a  few 
days  he  repeated  the  operation  with  a  like  result,  but 
on  this  occasion  with  the  handle  of  a  tooth  brush  well 
oiled.  Again  he  experienced  pleasure  which  was  dis- 
tinctly referable  to  the  penis.  After  this  he  often  per- 
formed this  act,  using  always  the  same  article  with 
which  to  accomplish  his  purpose. 

At  about  the  age  of  ten  he  was  initiated  into  mastur- 
bation and  pederasty  by  the  boys  of  a  boarding-school 
to  which  he  was  sent.  Masturbation,  however,  gave 
him  no  pleasure,  neither  did  pederasty  when  he  was  the 
active  agent.  Indeed  he  had  difficulty  in  getting  an 
erection  sufficiently  vigorous  for  the  purpose.  His 
weakness  in  this  respect  was  soon  discovered,  and  he 
was  relieved  from  that  part  of  the  performance  very 
much  in  accordance  with  his  wishes,  as  the  role  of  the 
passive  gave  him  more  pleasure  than  that  of  the  active 


ABSENCE    OF   SEXUAL   DESIRE.  57 

agent.  Every  night,  therefore,  he  took  part  in  these 
shameful  performances  and  frequently  to  the  extent  of 
half  a  dozen  or  more  times.  On  each  occasion  he  ex- 
perienced the  voluptuous  sensations  to  obtain  which 
was  rapidly  becoming  one  of  the  chief  objects  of  his 
life.  He  remained  at  the  school  five  years,  and  then  left 
it  to  go  into  a  tobacco  mercantile  establishment  to  learn 
the  business,  but,  as  he  said,  with  his  health  shattered, 
his  nervous  system  irritable,  with  almost  constant  head- 
aches, and  with  such  a  degree  of  relaxation  of  the 
sphincter  ani  as  to  sometimes  make  it  impossible  for 
him  to  hold  his  feces  after  they  had  once  reached  the 
rectum. 

At  this  time  he  formed  an  association  for  pederastic 
purposes  with  a  young  man  who  was  to  take  the  active 
while  he  himself  took  the  passive  part.  Articles  of 
agreement  were  drawn  up  between  them  in  which  each 
swore  eternal  fidelity  to  the  other,  and  in  which  they 
were  called,  respectively,  husband  and  wife.  They  took 
a  room  together  and  at  night  slept  in  one  bed.  There 
were  two  beds  in  the  room  and  both  were  occupied  for 
a  few  minutes  so  as  not  to  excite  suspicion,  and  then  the 
one  who  was  in  this  disgusting  arrangement  to  act  the 
part  of  the  "  husband  "  came  to  his  "  wife's  "  bed  and  re- 
mained there  during  the  night.  Generally  pederasty 
was  practiced  night  and  morning. 

Frequently  the  passive  agent  would  array  himself  in 
female  attire  and  would  sit  up  at  night  waiting  for  the 
other  to  return  home — sometimes  he  was  kept  out  late 


58  SEXUAL   IMPOTENCE   IN   THE    MALE. 

by  his  business,  which  was  that  of  a  Hqiior  dealer — and 
then  would  receive  him  with  every  demonstration  of 
affection. 

These  relations  continued  for  three  years,  at  the  end 
of  which  time  the  passive  agent  went  into  business  as  a 
cigar  dealer,  and  his  associate  was  obliged  to  leave  the 
city,  in  consequence  of  a  difificulty  with  the  police  in 
regard  to  a  gambling  operation  in  which  he  was  en- 
gaged. The  connection  was,  therefore,  broken  up, 
though  with  much  regret  and  many  manifestations  of 
grief  on  both  sides.  He  then  resumed  his  performances 
on  himself,  though  he  was  constantly  on  the  lookout 
for  a  man  with  whom  he  could  establish  rapports,  such 
as  those  which  had  been  interrupted.  He  frequently 
fell  in  love  at  first  sight,  but  was  afraid  to  make  ad- 
vances, lest  he  should  be  refused,  and  perhaps  exposed. 
All  this  time  he  had  a  very  lively  sense  of  the  impro- 
priety and  illegality  of  his  proceedings.  He  knew 
that  if  detected  disgrace  and  severe  punishment  would 
be  the  result.  He  endeavored,  however,  to  reconcile 
his  mind  to  his  conduct,  by  endeavoring  to  persuade 
himself  that  he  could  not  help  doing  what  he  did  ;  that 
the  tendency  was  born  in  him,  and,  that  though  his  body 
was  that  of  a  man,  his  soul  was  a  woman's.  He  gave 
himself  a  woman's  name,  calling  himself  "Lida"  when- 
ever he  was  operating  on  himself,  and  insisting  on 
being  called  so  by  his  acquaintances,  telling  them 
some  story  about  its  being  an  abbreviation  of  his  real 
name. 


ABSENCE   OF   SEXUAL   DESIRE.  59 

In  all  his  life,  he  had  never  experienced  the  slightest 
sexual  feeling  for  women.  Upon  one  occasion  he  had 
passed  the  part  of  a  night  with  a  prostitute,  but  was 
unable  to  have  connection,  or  even  to  have  an  erection. 
Since  about  his  fifteenth  year  he  had  had  strong  erec- 
tions while  engaged  in  pederasty,  and  emissions  of  se- 
men took  place  at  each  performance,  though  without 
there  being  any  contact  with  the  penis.  Indeed,  this 
organ  was  in  such  a  hyperassthetic  state  while  the  act 
was  being  performed  on  him,  that  he  could  not  bear  it 
to  be  touched.  The  least  contact,  even,  with  his  cloth- 
ing, was  sufficient  to  produce  a  semi-epileptic  paroxysm, 
in  which,  while  there  was  no  loss  of  consciousness,  there 
were  involuntary  contraction  of  the  muscles  of  the  face, 
arms,  and  legs  of  both  sides  of  the  body,  and  an  imme- 
diate relaxation  of  the  sphincter  of  the  bladder,  at- 
tended with  discharge  of  whatever  urine  might  be  in 
the  viscus.  This  condition  of  enuresis  was  often  mani- 
fested during  sleep,  but  more  especially  when  there  had 
been  no  sexual  relations  that  night. 

Finally  he  formed  a  pederastic  association  with  a  man 
of  about  fifty  years  of  age.  As  he  said,  it  was  not  the 
kind  he  wanted,  but  he  had,  as  he  declared,  no  alterna- 
tive. This  man  proved  to  be  very  salacious,  and  some- 
times had  relations  with  him  three  or  four  times  in  the 
course  of  the  day  and  night.  He  had  several  times 
been  under  the  charge  of  a  surgeon  of  the  city  for  fis- 
sure of  the  anus,  but  had  never  revealed  the  real  circum- 
stances to  him. 


6o  SEXUAL   IMPOTENCE   IN   THE   MALE 

About  a  year  before  he  came  under  my  observation 
he  had  had  an  epileptic  fit  during  pederastic  intercourse. 
This  was  after  having  had  such  connection  four  times 
in  the  course  of  one  night,  when  he  was  greatly  ex- 
hausted, and  in  an  exceedingly  h3-peraesthetic  condition. 
During  this  attack  he  bit  his  tongue.  After  this  he 
had  repeated  seizures,  some  taking  place  during  the 
pederastic  acts,  and  others  just  after  they  were  ended. 
All  were  apparently  directly  connected  with  them,  ex- 
cept the  two  last,  which  had  occurred  while  he  was  in 
his  shop,  and  engaged  in  his  legitimate  business.  In 
the  second  of  these  he  had  fallen  against  a  hot  stove 
and  burnt  his  hands  and  chest  quite  severely.  It  was 
for  treatment  for  his  epileptic  convulsions  that  he  came 
to  me. 

As  soon  as  he  entered  my  consulting  room,  I  was  sure, 
from  his  appearance  and  manner,  that  there  was  some 
derangement  of  the  genital  system,  but  I  was  not  pre- 
pared for  the  horrible  instance  of  depravity  the  details  of 
which,  after  some  difficulty,  I  succeeded  in  eliciting  from 
him.  Here  was  a  man  about  twenty-three  or  twenty- 
the  four  years  of  age  who  for  nearly  twenty  years  had 
had  sexual  orgasm  in  the  strangely  unnatural  way  men- 
tioned,  more  times  than  an  average  of  once  daily.  He 
informed  me  that  he  had  made  a  calculation,  and  was 
sure  that  he  had  either  acted  upon  himself  or  been 
acted  upon  by  others,  at  least  ten  thousand  times  !  He 
was  exceedingly  thin  ;  his  eyes,  black,  were  deep  sunken 
in  their  sockets,  his  hair  was  black,  thin,  and  dr}^ ;  he 


ABSENCE   OF   SEXUAL  DESIRE.  6l 

had  no  beard,  and  but  a  slight  mustache  ;  his  skin  was 
sallow,  and  the  expression  of  his  face  that  of  a  person 
who  has  committed  a  crime,  and  is  fearful  of  being  dis- 
covered. While  speaking,  he  kept  his  eyes  cast  towards 
the  floor.  After  he  had  told  me  the  story  as  1  have 
given  it,  I  proceeded  to  examine  him  more  critically. 
I  found  that  he  had  had  repeated  headaches,  and  at- 
tacks of  vertigo  ;  that  he  had  scarcely  any  appetite,  that 
he  suffered  greatly  from  dyspepsia,  that  his  bowels  were 
sometimes  constipated,  and  sometimes  extremely  loose; 
that  he  had  pains  in  his  back,  and  that  he  had  had  for 
several  months  past,  sharp,  shooting  electric-like  pains 
in  his  legs,  which  he  had  taken  for  neuralgic  pains,  but 
which,  from  the  peculiar  gait,  the  absence  of  the  patellar 
tendon-reflex,  and  the  presence  of  other  symptoms,  were 
certainly  indicative  of  the  existence  of  locomotor  ataxia. 
He  also  had  incontinence  of  urine,  and  the  ordinary 
phenomena  of  incoordination,  met  with  in  the  affection 
in  question.  On  submitting  him  to  ophthalmoscopic 
examination,  I  ascertained  that  the  left  pupil  was  very 
considerably  larger  than  the  right,  that  there  was 
neuro-retinitis  on  both  sides,  and  that  on  the  left  side 
there  had  been  several  retinal  haemorrhages.  The  field 
of  vision  was  considerably  restricted  in  that  eye.  At 
times  there  had  been  diplopia. 

Extending  my  examination  to  the  genital  organs,  I 
found  the  penis  extremely  small,  but  the  moment  I 
touched  it  an  involuntary  shudder  ran  through  his  body, 
and,  for  the  instant,  he  lost  consciousness — the  attack 


62  SEXUAL   IMPOTENCE   IN   THE   MALE. 

was  clearly  epileptic  in  character.  Although  he  could 
touch  and  handle  the  organ  with  comparative  impunity 
— though  when  he  retracted  the  prepuce,  there  were 
slight  spasms — it  was,  he  said,  impossible  for  any  one 
else  to  touch  it  without  an  epileptic  seizure  being  pro- 
duced. There  was  no  phimosis.  In  its  flaccid  state, 
the  penis  was  not  larger  round  than  a  man's  little  finger, 
and  did  not  exceed  two  and  a  half  inches  in  lensfth.  I 
suspected  from  this  conformation  that  he  had  taken  the 
active  part  in  pederasty,  as  well  as  the  passive,  to  which 
he  had  confessed,  but  he  assured  me,  that  he  had  never 
done  so  half  a  dozen  times  in  his  life  and  that  his  penis 
had  always  been  as  small  as  it  then  was.  The  testicles 
were  of  about  the  normal  size,  though,  perhaps,  some- 
what softer  than  they  are  usually  found  to  be  in  the 
healthy  state.  The  anus  was  extremely  relaxed  ;  to 
such  an  extent,  in  fact,  that  it  would  have  been  per- 
fectly easy  to  have  introduced  the  hand. 

He  informed  me  that  at  times  his  inclination  to- 
wards being  a  woman  was  so  great  that  he  had  been 
repeatedly  strongly  tempted  to  amputate  the  genital 
organs.  He  had  been  told  by  his  paramours,  however, 
that  if  he  did  so  he  would  no  longer  be  capable  of  ex- 
periencing pleasure  in  the  pederastic  act,  and  this  had 
restrained  him. 

But  with  this  tendency  to  femininity,  he  had  a  dis- 
gust for  women,  so  far  as  the  sexual  feeling  was  con- 
cerned ;  and,  as  has  been  said,  he  had  never  felt  in  the 
slightest  degree  any  venereal  excitement  in  their  pres- 


ABSENCE   OF   SEXUAL   DESIRE.  63 

ence  and  under  circumstances  calculated  to  produce 
the  orgasm  in  normally  constituted  men. 

There  was  nothing  to  do  for  this  patient,  so  far  as  I 
could  determine,  but  to  give  him  the  bromide  of  sodium, 
with  the  view  of  lessening  his  reflex  excitability  and 
arresting  the  epileptic  paroxysms,  to  which  he  was 
subject.  He  promised  to  abstain  from  further  peder- 
astic  acts,  but  I  had  no  confidence  in  his  protestations. 
Indeed,  he  said  that  he  did  not  himself  believe  that  he 
would  be  able  to  stop.  He  returned  in  about  a  week, 
better  so  far  as  the  epilepsy  was  concerned,  but  with  no 
improvement  in  other  respects.  He  had  committed 
pederasty,  passively,  five  times  in  that  period,  a  slight 
reduction  from  the  average.  I  saw  him,  at  intervals, 
for  several  months.  So  long  as  he  took  the  bromide 
he  was  better,  and  his  inclinations  to  his  vice  lessened 
in  number  and  intensity.  It  had  rendered  him  a  little 
weaker  in  his  legs,  however,  and  he  stopped  taking  it. 
His  ataxic  symptoms  steadily  became  niore  profound 
Finally  in  the  winter  of  1 880-1 88  r,  he  died  of  some 
lung  trouble,  in  Cuba,  whither  he  had  gone  for  his 
health. 

There  are  few  cases  on  record  in  which  a  more  de- 
cided inversion  of  the  sexual  feeling  has  been  exhibitea 
than  in  this  instance.  The  exact  mechanism  of  the 
production  of  the  orgasm  by  friction  against  the  muc- 
ous membrane  of  the  rectum,  is,  of  course,  easy  of  ex- 
planation ;  but  that  it  should  have  been  put  in  action 
at  so  early  a  period,  and  without  the  ordinary  physio- 


64  SEXUAL   IMPOTENCE   IN   THE    MALE. 

logical  process  being  developed,  are  certainly  remark- 
able facts.  And  again,  that  when  the  glans  penis  began 
to  exhibit  excitability,  it  should,  when  excited,  instead 
ot  leading  to  the  sexual  orgasm,  result  in  an  epileptic 
paroxysm  is  another  extraordinary  phenomenon. 

In  another  case,  the  patient,  a  young  man,  twenty- 
eight  years  of  age,  consulted  ir^e  for  treatment  for 
pederastic  tendencies  to  which  he  was  subject,  and  to 
which  he  had  repeatedly  yielded,  though  always  after- 
wards experiencing  the  most  intense  feelings  of  re- 
morse. He  had  never  had  sexual  intercourse  with 
women,  nor  had  desire  in  that  way.  He  had  attempted 
it  repeatedly,  in  order  that  he  might,  by  success,  be 
diverted  from  his  pederastic  inclinations,  but  had  never 
succeeded.  No  excitations  in  connection  with  women 
caused  him  any  sexual  excitement.  He  was  absolutely 
impotent  with  them. 

This  patient  was  of  a  different  type  from  the  other. 
He  was  well  educated,  had  travelled  extensively,  and 
had  ample  means  at  his  command.  His  family  was  of 
the  highest  respectability.  All  these  circumstances  in- 
creased the  deep  sorrow  he  felt  at  the  tendencies 
vvhich,  in  the  most  unaccountable  manner,  had  been 
developed  in  him,  and  which  had  produced  in  him  a 
feeling  of  the  most  profound  melancholy. 

The  origin  of  the  impulse  was  sudden,  and  occurred 
when  he  was  about  twelve  years  of  age.  He  had  been 
severely  flogged  at  school  for  some  boyish  offense,  and 
SGon  afterward  experienced  in  the  sexual  organs  sensa- 


ABSENCE   OF   SEXUAL   DESIRE.  65 

tions  which  he  had  never  felt  before,  accompanied  by 
an  erection  which  lasted  fully  half  an  hour.  That  after- 
noon, he  went  into  a  river  near  by  to  bathe,  in  company 
with  another  boy,  and,  while  in  the  water,  he  swam 
with  his  hands  resting  on  the  other  boy's  shoulders. 
He  had  often  done  this  before,  without  having  any 
sexual  excitement  provoked,  but  upon  this  occasion 
his  penis  came  in  contact  with  the  gluteal  region  of  his 
companion,  and,  instantly,  he  felt  just  such  sensations 
as  he  had  experienced  when  he  had  been  flogged,  and, 
like  them,  accompanied  by  an  erection.  They  were 
close  to  shore,  and  before  he  knew  what  he  was  doing, 
he  was  performing  a  pederastic  act.  From  this  time 
on,  while  at  school,  he  continued  the  practice,  some- 
times acting  as  the  passive,  but  generally  as  the  active 
agent.  When  he  left  school,  he  stopped  for  a  long 
time,  having  become  aware  of  the  iniquity  of  his  pro- 
ceedings, but  the  sight  of  a  naked  m.an,  or  even  the 
pictures  or  statutes  of  such  men,  were  sufficient  to 
cause  sexual  excitement,  but  not  reaching  to  the  extent 
of  emissions. 

While  at  college  he  studied  hard,  and  during  the 
four  years  of  his  attendance  never  once  yielded  to  his 
inclinations.  He,  however,  frequently  practised  mas- 
turbation, and  during  the  act  always  directed  his  mind 
toward  the  subject  of  the  gluteal  region  of  man,  of 
naked  men,  and  images  of  men  committing  pederasty. 
There  w^as  scarcely  a  night  that  he  did  not  commit  self- 
pollution.      Nocturnal  emissions,  also,  were  common, 


^  SEXUAL   IMPOTENCE    IN   THE    MALE. 

and  were  always  accompanied  by  lascivious  dreams^  of 
which  pederastic  acts  were  the  principal  features. 

All  this  injured  his  mind  and  weakened  his  genera' 
live  organs.  He  cursed  himself  for  his  mability  to  re- 
frain,  and  for  the  unnatural  course  which  his  sexual 
desires  took.  Several  times  he  had  attempted  to  turn 
them  towards  women,  but  in  vain.  They  were  abso- 
lutely incapable  of  rousing  in  him  the  least  venereal 
excitement.  He  read  romances  of  an  mdecent  charac- 
ter, in  which  women  were  made  to  act  lascivious  parts ; 
he  bought  obscene  pictures  and  looked  at  them,  hoping, 
by  these  means,  to  provoke  a  natural  desire  ;  but  he 
was  absolutely  dead  to  all  excitations  of  the  kind. 
These  things  disgusted  him,  and,  as  he  said,  Avhen  he 
saw  several  naked  prostitutes  in  obscene  positions,  he 
had  a  feeling  of  nausea  that  almost  ended  v.v  vomiting. 
The  society  of  virtuous  women  he  could  not  bring  him- 
self to  seek,  on  account  of  the  sense  of  his  utter  unfit- 
ness, by  reason  of  his  moral  turpitude  for  such  asso- 
ciations. He  was  fast  becoming  morbid  and  full  o/ 
eccentric  notions  relating  to  sexuality.  For  instance, 
he  spent  the  whole  of  one  evening  drawing  the  gluteal 
regions  of  the  great  men  of  the  world,  and  imagining 
that  he  was  having  pederastic  relations  with  them. 

Soon  after  leaving  college,  while  stopping  at  a  hotel 
in  this  city,  a  telegraphic  message  arrived  for  him  late 
in  the  evening,  just  as  he  had  undressed,  and  was  going 
to  bed.  The  bell-boy  of  the  hotel,  who  brought  it  lo 
him,  was  a  rather  handsome  lad,  and  excited  the  desires 


ABSENCE   OF   SEXUAL   DESIRE.  6^ 

of  the  patient  to  an  inordinate  degree.  He  offered  him 
a  considerable  sum  of  money  to  remain  with  him  all 
night,  and,  without  much  persuasion,  consent  was  ob- 
tained. He  had  never  experienced  such  intense  vene- 
real excitement  as  he  did  that  night,  and  he  committed 
pederasty  eleven  times  before  morning.  His  remorse 
over  this  was  very  great  and  his  ph3sical  suffering  ex- 
cessive. He  could  not  walk  for  several  days ;  had  con- 
stant headache,  and  could  not  sleep.  He  sent  for  an 
ounce  of  laudanum,  intending  to  take  the  whole  of  it, 
but,  on  reflection,  contented  himself  with  a  little  less 
than  a  teaspoonful.  This  gave  him  sleep,  and  some 
measure  of  relief  from  his  other  nervous  symptoms. 
He  recovered,  however,  went  to  Europe,  and  there  in- 
dulged several  times.  Then  he  returned  to  New  York, 
indulging  two  or  three  times,  and,  finally,  he  came  to 
me,  as  I  have  stated. 

I  found  that  he  was  sincerely  desirous  of  being  cured 
of  his  tendencies,  and  of  recovery.  He  had,  with  this 
latter  end  in  view,  formed  the  acquaintance  of  a  young 
lady,  but  as  he  had  never  experienced  any  sexual  incli- 
nations towards  women,  he  was  afraid  to  think  serious- 
ly of  matrimony.  Thus  far,  there  had  been  apparently 
no  serious  inroads  committed  on  his  health,  except  as 
regarded  his  mind.  He  was  subject  to  severe  fits  of 
depression,  during  which  he  suffered  the  keenest  feel- 
ings of  remorse,  and  had  thoughts  of  suicide.  He  had 
never  before  consulted  a  physician. 

I  advised  contmuous  association  with  virtuous  women, 


68  SEXUAL   IMPOTENCE   IN   THE    MALE. 

and  a  system  of  severe  study  of  subjects  that  would 
require  abstract  thought  of  the  highest  kind.  I  sug- 
gested mathematics.  He  at  once  agreed  to  pursue  the 
exact  course  I  marked  out  for  him  in  these  respects. 

I  also  recommended  cold  baths  every  morning,  a 
liberal  diet,  and  plenty  of  outdoor  exercise,  either  of 
walking  or  horseback-riding. 

I  cauterized  the  nape  of  the  neck  and  the  lower  dor- 
sal and  lumbar  regions,  and  administered  the  bromide 
of  sodium,  in  fifteen  grain  doses,  three  times  a  day.  The 
cauterization  was  repeated  every  ten  days.  At  the  end  of 
the  third  month  there  had  been  a  very  decided  improve- 
ment. Bromism  had  been  produced  to  a  tolerably 
severe  degree,  and  with  its  appearance,  the  unnatural 
proclivities  towards  men  began  to  disappear.  He  no 
longer  had  images,  such  as  had  formerly  haunted  him, 
passing  through  his  mind,  and  he  could  look  at  a  nude 
statute  of  a  man  without  feeling  any  sexual  excitement. 
Occasionally,  however,  tlie  impulse  to  pederasty  would 
come  over  him,  but  it  lasted  only  for  a  few  minutes, 
and  was  never  yielded  to.  He  had  not,  however,  had 
any  inclination  towards  women.  He  had  had  but  one 
nocturnal  emission,  and  that  was  soon  after  beginning 
treatment. 

All  this  was  ver}^  favorable,  and  I  determined  to  con- 
tinue the  treatment  unchanged  for  another  period  ot 
three  months. 

At  the  end  of  this  time  there  had  been  still  greater 
amendment.     Sleep  had   become  regular   and    sound ; 


ABSENCE   OF   SEXUAL   DESIRE.  69 

his  melancholic  disposition  had  almost  disappeared ;  his 
abnormal  sexual  tendencies  no  longer  existed.  In  fact, 
there  was  no  venereal  excitement  of  any  kind.  There 
were  no  emissions,  no  erections.  Judging  that  the  bro- 
mide had  now  been  carried  far  enough,  and  that  he  had 
obtained  such  a  degree  of  control  over  himself,  as  to 
prevent  his  returning  to  his  former  habits,  I  stopped  its 
administration,  and  gave  him,  instead,  the  following 
prescription : 

5 .  Stry chniae  sulph gr-  i j- 

Acid,  hypophosph.  dil 31]". 

M.  ft.  sol.     Dose:  ten  drops  three  times  a  day. 

He  took  this  without  interruption  for  three  months. 
During  this  period  he  had  no  relapse,  The  images, 
which  formerly  excited  him  now  disgusted  him,  for  he 
associated  them  with  some  of  the  most  remorseful  feel- 
ings a  man  could  have,  and  he  had  begun  to  take  pleas- 
ure in  the  society  of  respectable  women.  He  had  not, 
however,  experienced  any  but  the  faintest  evidences  of 
sexual  excitement,  though  occasionally  he  had  felt 
slight  normal  desires. 

Over  a  year  has  now  (March,  1883),  elapsed,  and  he 
is  still  under  treatment,  though  I  have  not  seen  him  for 
two  months.  At  that  time  he  was  strong  and  healthy, 
free  from  all  pederastic  tendencies ;  in  fact,  entertain- 
ing the  liveliest  disgust  for  it,  and  thinking  seriously  of 
marriage.  He  had  had,  several  times,  natural  sexual 
desires,  accompanied  by  erections,  but  a  high  sense  of 
morality,  which  now  exists  in  him,  has  prevented  any 


70  SEXUAL   IMPOTENCE   IN   THE   MALE. 

yielding.  He  has  nerve  to  keep  himself  perfectly- 
chaste  till  his  marriage,  and  then  to  use  with  discretion 
whatever  power  he  may  have. 

These  cases  will  suffice  to  show  two  of  the  types  of 
pederasts.  There  are  others,  but  they  are  not  essen- 
tially different  from  those  that  have  been  described, 
and  the  pen  wearies  of  writing  of  such  moral,  physi- 
cal and  hygienic  iniquities. 

But  there  are  other  cases  which  require  consider- 
ation, and  which  also  lead  to  impotence,  by  causing 
a  loss  of  the  natural  desire.  Among  these  are  those 
instances  in  which,  without  manual  or  other  phy- 
sical interference,  the  act  o'i  ejaculation,  with  excite- 
ment, is  accomplished  by  a  simple  act  of  the  imagina- 
tion. A  man,  for  instance,  observes  some  woman,  who 
proves  to  be  capable  of  provoking  sexual  desire.  He 
concentrates  his  attention  on  her,  imagines  the  ap- 
pearance of  her  vulva,  and  that  he  is  effecting  entrance, 
and  then,  step  by  step,  by  an  effort  of  the  will,  brings 
before  his  mind's  eye  the  successive  stages  of  an  act  of 
sexual  intercourse,  and  ends  by  experiencing  the  full 
sexual  orgasm.  There  are  men  who  never  have  any 
other  form  of  orgasm  but  this ;  who  cannot  experience 
erections  from  the  reality,  but  who  accomplish  this, 
and,  in  the  way  I  have  mentioned,  readily,  and  often 
several  times  in  the  course  of  the  day.  As  one  of  them 
said  to  me,  "  \Vc  have  the  stimulating  influence  of  con- 
stant change,  which  we  could  never  get  in  real  sexual 
intercourse      Wc    have    the    pick   of    the    handsomest 


ABSENCE   OF   SEXUAL   DESIRE.  yi 

women  in  town,  and  the  enjoyment  is  infinitely  greater 
than  any  intercourse  could  be."  These  men  go  into  the 
street  cars,  the  theatres  and  other  public  places,  place 
themselves,  so  that  they  can  fix  their  eyes  on  the  centre 
of  a  woman's  body,  and  then  give  a  loose  rein  to  the 
imagination.  In  a  half  minute,  or  a  minute  at  furthest, 
the  orgasm  supervenes. 

Three  of  these  cases  have  come  under  my  observa- 
tion, and  I  have  heard  of  others  through  these  three. 
There  appears  to  be  a  sort  of  association,  or  fellowship, 
with  signs,  by  which  they  know  each  other.  They 
have  a  coarse  name  which  they  apply  to  themselves, 
and  to  each  other,  and  which  may  be  paraphrased  as 
"  a  man  who  has  mental  sexual  intercourse."  They 
profess  to  be  able  to  tell  by  sight  whether  or  not  a  man 
is  one  of  the  class  in  question. 

One  of  the  persons  of  the  kind  consulted  me  for  epi- 
lepsy, which  had  been  clearly  brought  about  by  the 
practice  to  which  1  refer.  For  several  months  he  had 
had  repeated  attacks  of  fully  developed  epileptic  parox- 
ysms, not  only  during  the  orgasms  produced  by  the 
method  mentioned,  but  at  night  during  sleep.  He  in- 
formed me  that  several  of  his  class  had  "fits."  This 
man  had  repeatedly  had  convulsions  in  the  street,  rail- 
way cars  and  other  places.  The  last  one  had  occurred 
in  a  picture-dealer's,  a  favorite  place,  with  him,  to  ob- 
serve nice-looking  women.  Having  selected  his  "part- 
ner," he  fixed  his  mind  on  her  strongly,  and  imagined 
her  in  various  lascivious  positions.     He  had  no  diffi- 


72  SEXUAL    IMPOTEN'CE    IN    THE    MALE, 

culty,  he  said,  in  bringing  her  image  vividly  before  his 
mind  in  an  entirely  nude  state.  Theii  he  went  through 
a  series  of  voluntary  contractions  of  the  gluteal  and 
accelerator  urinas,  and,  perhaps,  other  muscles,  and  in 
less  than  a  minute,  generally,  the  emission  with  the  or- 
gasm took  place.  Sometimes,  while  mentally  engaged 
with  one  woman,  another  would  enter  the  apartment, 
handsomer  or  otherwise  more  attractive,  and  then  he 
would  change  to  her.  He  was  able  also  to  produce 
the  orgasm  by  thinking  of  some  woman  whom  he  had 
previously  seen,  without  the  necessity  of  her  being 
present  before  him.  As  to  actual  sexual  intercourse,  it 
gave  him  no  pleasure,  he  was  absolutely  impotent  with 
women  and  not  even  the  imagination  sufficed  to  awaken 
his  desires  in  the  attempt  at  connection. 

Latterlv,  he  had  been  unable  to  restrain  the  disposi- 
tion to  the  production  of  the  orgasm,  which  often  took 
place  at  the  mere  sight  of  an  attractive  woman,  and 
without  being  accompanied  by  an  erection.  At  times 
there  was  no  emission.  Again,  a  painting  or  engraving 
of  a  woman,  either  clothed  or  in  a  nude  or  partially 
nude  state,  would  cause  an  orgasm  with  or  without 
erection  or  seminal  ejaculation. 

In  this  case,  the  penis  and  testicles  were  apparently  in 
good  condition,  and  there  appeared  to  be  no  hyperees- 
thetic  condition  of  the  glans.  He  complained,  how- 
ever, of  a  burning  sensation  in  the  urethra  whenever  he 
passed  his  urine,  and,  on  examination,  I  found  an  irrita- 
ble state  of  the  prostatic  portion  of  the  canal. 


ABSENCE   OF   SEXUAL   DESIRE.  73 

I  treated  this  patient  with  large  doses  of  bromide  of 
sodium,  twenty  grains  three  times  a  day,  and  with 
urethral  injections  of  cold  water.  His  mental  condition 
was  entirely  cured  in  the  course  of  a  few  months,  and 
the  epilepsy  was  prevented  while  he  continued  to  take 
the  bromide.  After  that  time  I  lost  sight  of  him  and, 
therefore,  do  not  know  whether  there  was,  or  not,  any 
improvement  in  regard  to  the  impotence.  Probably 
there  was  not. 

The  other  cases  were  similar  in  general  features  to 
this  one.  Epilepsy  had  been  developed  in  each,  but,  as 
I  only  saw  them  once,  I  do  not  know  the  effects  of  the 
treatment. 

The  particulars  of  an  interesting  case  of  sexual  per- 
version and  impotence  have  been  given  me  by  a  medi- 
cal friend  of  this  city,  and  with  his  permission  I  cite 
them  here. 

The  subject  was  a  foreign  gentleman,  about  thirty- 
five  years  of  age,  whose  whole  life  had  been  devoted  to 
the  gratification  of  his  sexual  appetite,  and  who  seldom 
kept  less  than  three  mistresses  at  a  time.  When  thirty 
3'ears  old  he  had  married,  but  soon  afterward  his  wife 
left  him  in  consequence  of  his  failing  sexual  powers 
and  her  objections  to  his  mode  of  life. 

Ordinarily  he  was  unable  to  have  an  erection  without 
obliging  her  to  clothe  herself  in  various  fancy  costumes, 
and  to  assume  different  positions,  while  he  would  sit 
and  look  at  her  till  the  desired  result  was  obtained. 
Again,  he  would  cause  her  to  dress  in  a  short,  colored 


74        SEXUAL  IMPOTENCE  IN  THE  MALE. 

chemise,  and  colored  silk  stockings,  and  then  while  she 
lay  on  a  lounge  he  would  regard  her  sometimes  for 
over  an  hour  before  erection  ensued.  After  a  time  this 
procedure  failed,  and  he  then  resorted  to  the  expedient 
of  dressing  her  in  the  costumes  of  different  nations,  Per- 
sian, Egyptian,  Hungarian,  Swiss,  etc.  That  these  eX' 
pedients  also  eventually  failed  there  can  be  no  doubt. 

A  case  is  reported,*  in  which  there  was  "  mental  inter- 
course" similar  to  that  referred  to  in  the  foregoing  in- 
stances, and  as  the  history  is  interesting  in  other  re- 
pects,  I  cite  it  without  abridgment. 

"  The  patient  is  a  highly  cultivated  gentleman  of  high 
moral  character,  the  father  of  three  or  four  healthy 
children,  the  result  of  an  unusually  happy  marriage. 
*  At  an  early  age,'  said  he,  *  long  before  puberty,  even, 
I  had  acquired  a  taste  for  indoor  games,  female  pursuits 
and  even  attire,  although  the  latter  desire  was  never 
satisfied  farther  than  wearing  girls'  shoes.  I  was  also 
an  admirer  of  small  waists  in  ladies  and,  at  the  age 
of  fourteen,  tried  to  procure  or  make  for  myself  a  pair 
of  corsets.  As  I  grew  older,  my  fondness  for  female 
dress  increased,  but,  having  no  sisters,  I  could  find  no 
opportunity  to  gratify  it,  farther  than  reading  stories  of 
female  impersonations,  etc.  I  composed  several  stories 
entitled  'Adventures  in  Hoops,'  and  constructed  stories 
founded  on  such  plots.  Thev  were  printed  and  exten- 
sively copied     To  this  dav  I    seldom    miss   an  oppor- 

*  "  Gynomania:  A  curious  case  of  Masturbation."    The  Medical  Record, 
March  19,  i88i. 


ABSENCE   OF   SEXUAL   DESIRE.  75 

tunity  to  see  men  take  female  parts  on  the  stage,  espe- 
cially the  more  refined  ones,  like  Leon,  etc' 

"At  the  age  of  twenty-one  years,  he  began  the  use  of 
corsets,  of  which  he  is  still  very  fond,  and,  although  he 
laced  himself  very  tightly  for  several  years,  he  seems 
to  have  suffered  no  injury  from  it.  He  confessed  that 
he  had  always  derived  a  certain  amount  of  sensual  grat- 
ification from  their  use,  and  although,  at  first,  he  ex- 
perienced some  pain  in  the  pubic  region,  and  erections, 
he  has  since  found  that  as  soon  as  his  corsets  are  pulled 
quite  tight,  erections  cease,  and  that  coition,  as  well  as 
voluntary  discharges,  are  impossible  when  he  is  tightly 
laced. 

"  From  fear  of  impotence  or  other  evil  that  might  re- 
sult from  masturbation  before  marriage,  he  carefully 
avoided  voluntary  discharges  of  semen  and  remained 
continent  before  marriage.  He  recollects,  however, 
having  had  three  involuntary  emissions  while  awake. 
The  first  occurred  while  horseback  riding,  and  induced 
him  to  abandon  this  otherwise  healthful  exercise.  The 
others  happened  while  putting  on  a  pair  of  very  tight 
shoes  (ladies'  boots,  with  French  heels)  and  buttoning 
them. 

"  After  marriage  he  abstained  from  corsets  and  other 
articles  of  female  attire  (with  rare  exceptions),  until  two 
children  had  satisfied  him  of  his  potency. 

"About  this  time  our  patient  began  to  yield  to  the 
temptations  which  everywhere  beset  him,  and  returned 
to  the  very  source  whence  he  had  first  derived  unlaw- 


^6  SEXUAL   IMPOTENCE   IN   THE    MALE. 

ful  pleasure.  But  I  will  let  him  tell  it :  '  I  purchased,' 
said  he,  '  a  very  stylish  pair  of  ladies'  high  boots,  with 
French  heels,  which  were  at  first  tight  enough  to  make 
me  limp.  These  boots  he  boldly  wore  upon  the  prom- 
enade in  fine  weather,  with  trousers  elevated  to  show  the 
heel.  In  bad  weather  he  was  wont  to  put  on  these 
boots  and  button  them  in  front  of  a  long  mirror,  about 
once  a  week.  This  seldom  failed  to  cause  not  only  an 
erection,  but  also  an  emission. 

"  When  this  had  lost  its  novelty,  he  purchased  a  pair 
of  corsets,  not  having  worn  them  since  marriage.  As 
often  as  practicable  with  concealment  he  wore  these, 
and  laced  them  sometimes  to  faintness.  These  two  art- 
icles, buttoned  boots  and  corsets,  seemed  to  have  a  most 
peculiar  infatuation  for  him.  Often  while  riding  in  a 
street  car,  if  a  lady  with  a  small  waist  or  pretty  foot  sat 
opposite,  he  would  have  a  sort  of  mental  coition,  he 
called  it,  with  this  innocent  paramour — an  emission. 
M.  Roubaud  mentions  the  only  case  at  all  similar,  where 
a  young  man  was  impotent,  except  with  a  light-haired 
woman  wearing  corsets,  high  boots,  and  a  silk  dress. 
The  last  three  articles  had  a  powerful  influence  on  our 
patient,  whether  they  were  worn  by  man  or  woman. 

"  After  this  he  descended  step  by  step  down  the  ladder, 
purchasing  various  articles  of  female  attire,  until  at 
length  he  bought  a  black  silk  dress,  which  he  had  made 
to  fit  him  very  tightly,  and  in  which  he  took  great  pride. 
Curls  and  switches,  false  hair,  earrings  and  breast  pins, 
all  aided  in  feeding  this  peculiar  fire.     He  would  even 


ABSENCE   OF   SEXUAL   DESIRE.  -J"] 

sit  for  hours  tightly  laced,  while  a  ladies'  hair-dresser 
curled  and  frizzed  his  hair  like  a  woman's.  At  length  he 
went  so  far  as  to  walk  the  city  streets,  and  even  attend 
church,  wearing  his  new  black  silk  dress,  caught  up  on 
one  side  so  as  to  expose  a  white  fluted  skirt,  beneath 
which  his  high-heeled  French  boots  were  visible.  With 
heavily  padded  chest,  tightly  squeezed  waist,  enormous 
bustle,  his  hair  tortured  into  fantastic  forms,  his  ears  in 
screw-vises,  and  fiis  feet  crowded  into  the  narrowest, 
and  most  uncomfortable  boots,  he  would  walk  for  miles, 
or  dance  for  hours,  with  great  pleasure.  In  fact,  physi- 
cal pain  seemed  essential  to  his  happiness,  and  he  thor- 
oughly  and  deeply  enjoyed  it,  if  it  were  only  the  pain 
inflicted  by  female  attire.  He  imitated  women's  manner 
and  habits  to  some  extent,  yet  never  used  his  disguise 
for  improper  purposes,  except  to  excite  an  occasional 
emission. 

"  As  before  stated,  he  had  always  been  an  advocate 
of  tight-lacing,  had  read  extensively  upon  the  subject, 
and  collected  all  the  literature  that  in  any  way  favored 
or  defended  it.  He  several  times  tried  to  lace  himself 
tightly  enough  to  faint  away,  but  never  could.  He 
even  persuaded  his  wife  to  lace,  and  daily  tightened 
her  corsets,  until  he  actually  reduced  her  waist  nearly 
six  inches,  which  also  gave  him  sensual  gratification. 
A  child  born  of  her  soon  after  was  perfectly  healthy  and 
well  formed. 

"  He  showed  me,"  continues  Dr.  H.,  the  physician  who 
reports   the   case,  "  several  pictures  of  himself,  in    all 


78  SEXUAL   IMPOTENCE   IN   THE    MALE. 

sorts  of  dresses  :  as  a  ballet-girl,  as  Queen  Elizabeth,  as 
a  Polish  maiden,  an  old  maid,  the  Goddess  of  Liberty, 
as  Juliet,  and  in  a  plain  street-dress,  which  he  wore 
to  church  a  few  3'ears  ago. 

"  Many  times  he  swore  off,  but  in  vain.  Sometimes 
he  would  remain  free  from  his  peculiar  vice  for  weeks 
and  months,  when  it  would  return  with  renewed  vigor. 
I  found  him  eating  largely  of  animal  food,  but  not  of  fat 
meat.  Nitrogenous  food  alone  suited  his  palate.  I  ad- 
vised vegetable  diet,  but  he  found  it  distasteful  to  such 
a  degree  that  I  was  forced  to  withdraw  it.  He  used  no 
stimulants  except  weak  tea  and  coffee.  Gave  bromides 
for  awhile  and  hope  at  length  to  conquer." 

Sometimes  there  is,  in  individuals  of  a  peculiarly  im- 
pressionable nervous  organization,  sexual  impotence  as 
regards  all  women  except  those  of  a  peculiar  type,  or 
clothed  in  a  particular  manner,  or  possessing  some  pe- 
culiarity, to  which  the  person  has  become  accustomed. 
Thus,  in  the  case  cited  above  from  Roubaud,  *  the 
patient  was  impotent  to  all  women  different  from  the 
one  with  whom  he  had  previously  had  sexual  rela- 
tions. 

"  M.  X.,  son  of  a  general  of  the  first  Empire,  was 
brought  up  at  his  father's  country  seat,  which  he  did 
not  leave  till  he  was  eighteen  years  of  age,  when  he 
went  to  the  military  school.  During  this  long  period 
of  isolation  in  the  country,  he  had  been  initiated,  at  the 

*  "  Traite  de  I'impuisance  et  de  la  sterilite,"  etc.,  Troisieme  edition. 
Paris,  1S76,  p.  373. 


ABSENCE   OF   SEXUAL   DESIRE.  79 

age  of  fourteen,  into  an  experience  of  the  pleasures  of 
love,  by  a  young  lady,  a  friend  of  the  family.  This 
lady,  then  twenty-one  years  old,  was  a  blonde,  wore 
her  hair  in  the  English  style,  that  is  to  sa}',  in  corkscrew 
curls,  and  in  order  to  lessen  the  liability  of  detection  in 
her  amorous  intrigue,  she  never  had  intercourse  with 
her  young  lover  except  when  clothed  in  her  day  attire, 
that  is  to  say,  wearing  gaiter  boots,  corsets  and  a  silk 
gown. 

"  All  these  details  I  mention  purposely,  for  they  had 
greater  influence,  not  only  over  the  degree  of  excita- 
bility of  the  genital  function,  but  over  its  very  existence, 
in  the  case  of  M.  X. 

"  The  young  lady  was  of  strong  passions,  and  as  it 
appeared,  exhausted  the  strength  of  the  young  neo- 
phyte, and  the  severe  regimen  of  the  military  school 
was  no  more  than  sufficient  to  restore  to  the  genital 
organs  the  energy  which  had  been  seriously  affected 
by  too  early  and  too  frequent  indulgence. 

"  But  when  the  period  of  his  study  had  passed,  and 
he  was  sent  to  a  garrison,  and  was  disposed  to  enjoy 
the  rights  which  nature  had  restored,  he  perceived  that 
sexual  desire  was  only  provoked  by  certain  women, 
and  with  the  concurrence  of  certain  circumstances. 
Thus,  a  brunette  did  not  produce  in  him  the  slightest 
emotion,  and  a  woman  in  her  night-dress  was  sufficient 
to  extinguish  and  freeze  every  amorous  transport. 

"  In  order  that  he  might  experience  the  venereal 
desire,  it  was  necessary  that  the  woman  should  be  a 


80  SEXUAL   IMPOTENCE    IN   THE    MALE. 

blonde,  should  wear  gaiter  boots,  should  be  laced  in  a 
corset,  wear  a  silk  gown,  and,  in  a  word,  fulfill  all  the 
requirements  of  the  lady  who  had  first  caused  M.  X.  to 
experience  the  sexual  orgasm. 

"  And  this  was  not  by  reason  of  any  sentimental  love, 
the  magic  power  of  which  lasts  through  a  lifetime.  In 
his  early  sexual  relations,  M.  X.  had  only  been  actuated 
by  animal  desire.  His  heart  had  never  been  touched, 
and  after  twenty-five  years,  in  consulting  me  for  his 
singular  infirmity,  he  declared  that  he  had  loved  with 
his  heart  but  one  woman,  and  to  her  he  had  never  been 
able  to  render  homage  for,  by  a  perverse  coincidence, 
she  was  a  brunette. 

"  His  fortune,  his  name,  his  social  position,  made  it  a 
duty  of  M.  X.  to  marry,  but  he  had  always  resisted  the 
solicitations  of  his  family  and  his  friends,  for  he  knew 
that  he  would  be  incapable  of  availing  himself  of  his 
marital  rights,  with  a  wnfe  arrayed  in  the  costume  of 
the  nuptial  bed.  Yet  he  was  in  good  health,  was  of  the 
sanguino-choleric  temperament,  was  above  the  medium 
height  and  was  of  so  strong  a  constitution  that  for  fif- 
teen years  he  had  been  an  ofificer  in  a  regiment  of  heavy 
cavalry. 

"  Evidently  his  impotence  was  relative  onh',  for,  when 
the  woman  was  blonde  and  when  the  other  conditions 
specified  existed,  he  accomplished  the  sexual  act  with 
all  the  ardor  of  a  healthy  man  and  one  of  an  amorous 
disposition. 

"  Retiring  to  civil  life,  and  tormented  more  than  ever 


ABSEN'CE    OF    SEXUAL    DESIRE.  8l 

by  his  family  on  the  subject  of  his  marriage,  he  was 
anxious  to  make  a  last  effort,  and  accordingly  consulted 
me." 

This  patient  was  cured  by  moral  means,  to  which  ref- 
erence will  be  more  fully  made  hereafter. 

These  cases  of  impotence  as  regards  certain  women, 
while  there  is  full  sexual  power  with  others,  are  not  in- 
frequently met  with  in  medical  practice,  and,  indeed, 
relative  want  of  desire  may  be  regarded  as  in  some  re- 
spects a  normal  phenomenon.  A  young  man  of  strong 
passions,  and  yet  educated  and  refined,  will  not  be  like- 
ly to  exhibit  desire  toward  an  old,  and  ugly,  and  other- 
wise disagreeable  hag.  No  matter  how  vigorous  the 
animal  part  of  his  organism  might  be,  or  energetic  the 
erection,  both  would  give  way,  in  presence  of  the  ab- 
solute failure  of  sexual  desire.  But  there  are  cases  such 
as  that  cited  from  Roubaud,  in  which  even  trifling  cir- 
cumstances or  conditions,  or  the  influence  of  some  long- 
continued  habit,  abolishes  all  desire,  and  renders  the 
individual,  for  the  time  being  at  least,  impotent  unless 
the  situation  is  in  every  respect  assimilated  to  that  to 
which  he  is  accustomed.  I  have  already  given  in- 
stances in  which  this  state  existed  in  regard  to  all  wo- 
men, and  in  which  unless  certain  preliminaries  were 
provided  for,  connection  was  not  only  impossible,  but 
was  often  repulsive. 

The  absence  of  desire  on  the  part  of  a  young  man 
towards  an  old  and  ugly  woman  is  an  entirely  natural 
phenomenon,  and  one,  therefore,  not  calling  for  medical 


82  SEXUAL   IMPOTENXE    IX   THE    MALE. 

treatment,  but  cases  like  the  following  are  certainly 
more  or  less  abnormal,  and  are  such  as  in  regard  to 
which  physicians  are  often  consulted. 

A  married  gentleman,  who  before  entering  into  the 
matrimonial  state,  had  been  excessively  given  to  sexual 
intercourse,  but  who  had  no  reason  to  think  that  his 
powers  were  exhausted,  or  even  materially  weakened, 
found  himself  on  his  wedding  night  and  for  some  days 
thereafter,  absolutely  incapable  of  consummating  the 
marriage.  His  wife  was  a  highly  educated,  inteUigent, 
refined  and  beautiful  woman  ;  he  was  devotedly  attached 
to  her,  and  on  marrying  had  once  and  for  all  given  up 
all  the  evil  associations  of  his  younger  days.  His  passions 
were  strong,  but  as  soon  as  he  attempted  intercourse, 
the  desire,  which  he  had  previously  entertained,  van- 
ished at  the  thought  that  it  was  a  profanation  for  a 
man  like  him  to  subject  so  beautiful  and  pure  a  woman 
to  such  an  animal  relation  as  sexual  intercourse.  "  She 
is  too  good  for  me,"  he  would  say  to  himself,  "  I  ought 
to  have  married  a  woman  used  to  this  sort  of  thing ;  or, 
better  still,  have  remained  single  and  gone  on  in  the 
old  way."  This  happened  several  times,  and  then,  in 
disgust  with  himself,  he  paid  a  visit  to  one  of  his  former 
female  associates,  and  in  a  short  time  satisfied  himself 
that  his  powers  were  as  good  as  ever.  Again  he  es- 
sayed the  act  with  his  w'lie,  and  again  he  met  with  dis- 
appointment. 

He  had  now  been  married  a  w^eek,  and  the  marriage 
was  still  unconsummated.    He  then  came  under  mv  care. 


ABSENCE   OF   SEXUAL   DESIRE.  83 

A  case  like  his  presented  very  little  difficulty  :  I  re- 
minded him  of  the  fact  that  in  all  probability,  however 
pure  and  noble  his  wife  might  be,  there  was  no  profa- 
nation in  sexual  intercourse,  chastely  undertaken;  that 
she  had  sexual  organs  which  were  intended  for  the  per- 
formance of  certain  functions;  that  these  functions  were 
all  connected  with  the  propagation  of  the  human  spe- 
cies ;  that  there  was  but  one  way  that  I  knew  of  by  which 
the  species  could  be  propagated  ;  that  she  had  selected 
him  as  the  one  man  who  was  to  put  her  in  the  way  of 
fulfilling  her  office  in  the  grand  scheme  of  nature,  and 
that  my  advice  to  him  was  to  lower  his  estimate  of  her 
angelic  character,  and  to  look  upon  her  in  the  not  less 
worthy  light  of  a  woman  to  be  treated  as  other  women 
are  treated  under  like  circumstances.  He  left,  promis- 
ing to  be  less  exalted  in  his  appreciation,  but  the  next 
morninof  returned  with  the  information  that  it  was  no 
use :  he  had  tried  his  best,  his  erections  were  strong 
and  repeated,  but  as  soon  as  he  went  further  towards 
the  object  he  had  in  view  his  desire  became  utterly  ex- 
tinguished. "  She  was  too  good,  too  delicate  for  a 
mere  animal  like  him  ;  he  could  not  desecrate  her  beau- 
tiful body  by  any  such  vile  act,"  etc.,  etc. 

From  a  few  words  which  he  let  drop,  I  became  con- 
vinced that  the  lady  was  not  so  platonic  a  creature  as 
he  thought,  and,  that  if  I  could  have  a  few  words  of 
conversation  with  her,  I  could  probably  end  the  matter 
to  the  satisfaction  of  both  parties.  I  therefore  expressed 
a  wish  to  see  his  wife,  and  that  afternoon,  with  his  con- 


84  SEXUAL   IMPOTENCE   IN   THE    MALE. 

currence,  called  on  her  at  the  hotel  at  which  they  were 
stopping  during  their  wedding  tour  to  New  York.  I 
found  her  to  be  a  very  sensible  woman,  not  at  all 
etherial,  but  anxious  to  do  her  share  towards  relieving 
her  husband  from  his  embarrassing  position,  of  which 
she  only  half  comprehended  the  character. 

I  requested  her  to  be  a  little  more  free  in  her  manner 
with  her  husband  than  she  had  yet  been,  and  told  her  I 
thought  that  if  she  pursued  that  course  there  would  be 
no  further  disappointment,  but  that  she  was  not  to  act 
as  though  she  had  received  any  instruction  from  me, 
but  rather  as  though  she  was  disregarding  what  I  had 
said  to  her.  The  details,  of  course,  I  left  to  her  own 
good  sense  and  womanly  feeling.  The  plan  was  emi- 
nently successful,  as  her  husband  told  me  with  great 
glee  the  next  day.  "She  told  me,"  he  said,  "that  she 
did  not  want  any  doctors  about  her ;  that  she  could  set- 
tle this  affair  herself."  "  The  rest,"  he  continued,  "  is 
confidential  between  her  and  me,  but,  by  Heaven,  it  re- 
minded me  of  old  times!"  It  is  scarcely  necessary  to 
add  that  there  was  no  further  trouble. 

In  another  case,  the  patient,  a  gentleman  who  had 
been  married  several  years,  and  had  lived  happily  with 
a  wife  to  whom  he  was  much  attached,  found  himself 
absolutely  without  desire,  in  a  new  house  he  had  built 
for  himself.  He  had,  when  he  consulted  me,  lived  in 
his  new  mansion  six  or  seven  months,  and  in  all  that 
time  had  experienced  no  desire  for  intercourse.  He  was 
about  thirty  years  of  age,  and  his  wife  twenty-five. 


ABSENCE   OF   SEXUAL   DESIRE.  85 

He  consulted  me,  supposing  that  there  was  some  ner- 
vous trouble  threatening  the  extinction  of  his  virile 
powers.  I  found,  however,  on  examination,  that  the 
organs  were  in  a  perfectly- normal  condition,  that  he  had 
strong  erections  at  times,  and  had  had  several  nocturnal 
emissions.  I  suggested  that,  probably,  he  was  like  the 
boy  who  had  spelt  well  in  the  old  school-house,  but  who, 
when  reproved  by  his  teacher  for  retrograding  in  his 
orthography,  replied  that  "  he  could  not  get  the  hang 
of  the  new  school-house."  At  first,  he  doubted  the 
correctness  of  this  explanation,  but  upon  reflection 
became  satisfied  that  I  was  right.  To  "make  assur- 
ance doubly  sure,"  he  went,  with  his  wife,  to  the 
other  house,  which  was  awaiting  a  tenant,  and  pass- 
ing a  night  there,  was  very  soon  convinced  that 
the  former  state  of  affairs  could  be  easily  restored. 
What  to  do,  however,  was  the  next  question.  To  go 
back  to  his  old  residence  was  out  of  the  question,  and 
to  live,  as  it  appeared  to  him,  he  would  have  to  live  in 
the  new  one,  was  not  to  be  thought  of.  I  advised  that 
he  should  move  all  the  bed-room  furniture  from  his 
chamber  in  the  old  house  to  the  one  he  occupied  in  the 
new,  and  to  otherwise  fit  up  the  room  as  nearly  as  pos- 
sible like  the  one  to  which  he  had  been  so  long  accus- 
tomed. He  at  once  saw  the  propriety  of  this  sugges- 
tion, and,  adopting  it,  had  no  further  trouble.  Piece  by 
piece,  after  a  few  months,  he  displaced  the  old  furniture, 
and  this  without  any  sacrifice  of  his  normal  desires. 

Besides  these  classes  of  impotents,  complete  and  par- 


86  SEXUAL   IMPOTENCE   IN   THE   MALE. 

tial,  from  the  absence  of  desire,  there  are  others,  in 
whom  the  condition  is  irregularly  induced,  through  re- 
ligious observance  or  superstition,  and  in  whom  it  be- 
comes permanent  through  a  long  continuance  of  sexual 
abstinence.  Thus,  members  of  the  priesthood  in  certain 
denominations,  who  devote  themselves  to  a  life  of  celi- 
bacy and  self-abnegation,  eventually  become  absolutely 
free  from  desire,  and  consequently  impotent.  The  same 
is  true  of  whole  sects,  whose  religious  worship  requires 
an  entire  abstinence  from  sexual  intercourse.  Before 
the  stage  is  reached  at  which  desire  is  abolished,  great 
suffering  is  sometimes  undere-one,  as  was,  for  instance, 
the  case  with  St.  Anthony  and  others  of  those  with 
whom  the  complete  annihilation  of  sexual  inclinations 
was  considered  an  act  agreeable  to  God.  In  regard  to 
the  Shakers,  who  profess  to  abstain  from  intercourse, 
and  who  probably  do  so,  in  most  cases,  the  following 
account  exhibits,  to  some  extent,  the  state  of  mind  and 
body  thereby  induced. 

"  An  old  Shaker,  called  Father  Abijah  Worster  (who 
had  been  anointed  Father  in  Mother  Ann's  day),  a 
native  of  Harvard,  Mass.,  and  well  known  to  the  in- 
habitants of  that  town,  told  me,  that  one  time  some  of 
his  relatives  entered  and  clung  to  him.  I  will  relate 
his  story;  yet,  if  I  had  his  words,  I  should  lack  the  deep 
tone  of  thrilling  horror  which  invariabl)^  accompanied 
the  recital  of  such  scenes  by  these  visionary  people. 
He  says: 

"As  I  was  tossing,  tumbling,  rolling,  jumping,  throw- 


ABSENCE   OF   SEXUAL   DESIRE.  8/ 

ing  myself  against  the  wall,  the  chimney,  the  floor,  the 
chairs,  in  fact,  everything  that  did  not  keep  out  of  the 
way,  I  felt  that  my  blood  was  boiling,  and  every  bone 
in  my  body  was  being  sawn  asunder;  my  flesh  pinched 
with  hot  irons,  and  every  hair  on  my  head  Avas  a  sting- 
ing reptile.  I  had  laid  me  down  to  die,  when  Mother 
Ann  came  along,  saying,  'Why,  Abijah,  there  are  some 
of  the  worst  looking  spirits  on  your  shoulders  I  ever 
saw  in  my  life.'  I  crawled  along  and  laid  me  down  at 
her  feet,  and  prayed  her,  in  mercy,  to  help  me;  she 
raised  me  up,  and  made  a  few  resolute  passes,  from  ni}' 
head  to  my  feet,  with  her  hands,  and  I  was  relieved 
at  once — and  I  have  never  doubted  since;  that,'  he 
added,  'was  the  power  of  God  in  Mother.' 

"This  good  old  man  died  in  1839,  upwards  of  ninety 
years  of  age;  he  related  to  me,  as  a  Remarkable  Fact, 
a  few  weeks  before  his  death,  that  he  had  gained  a 
complete  dominion  over  all  the  passions  of  the  first 
Adam.  The  young  and  beautiful,  old  and  withered, 
were  the  same  to  him."  - 

A  patient  who  had  voluntarily  reduced  himself  to 
impotence  by  restraining  his  desires,  was,  several  years 
since,  under  my  charge.  Originally  of  strong  passions, 
he  had,  when  about  attaining  his  majority,  made  a  vow 
to  follow  the  example  of  Mani,  and  to  abstain  from  all 
voluntary  sexual  excitement.  He  devoted  himself  to 
the  study  of  philosophy,  with  the  view   of  founding  a 

*  Extract  from  an  unpublished  Manuscript  on  Shaker   History.     By 
an  Eye-Witness,      Boston,  1850. 


88  SEXUAL   IMPOTENCE   IN   THE    MALE. 

sect,  which  should  be  purer  in  their  lives  than  any  that 
had  previously  existed.  He  began  by  curbing  the  sex- 
ual passions,  and  proposed,  by  degrees,  to  suppress  all 
appetites,  except  those  absolutely  necessary  to  the  ex- 
istence of  the  individual,  and  these  were  to  be  indulged 
in  to  the  lowest  extent  consistent  with  the  preservation 
of  life.  As  I  have  said,  he  was  of  strong  sexual  feeling, 
and  for  a  long  time  he  suffered  very  acutely.  Libidi- 
nous images  were  constantly  before  him,  and  his  dreams 
were  only  of  sexual  matters,  of  all  possible  variety. 
During  this  period,  nocturnal  emissions  were  common 
occurrences.  The  deprivation  was  soon  calculated  to 
excite  disturbance,  from  the  fact,  that  up  to  the  period 
of  his  vow,  he  had  indulged  freely  and  had  kept  a  mis- 
tress from  the  time  that  he  was  seventeen  years  old. 
Finall}^  he  succeeded  in  overcoming  the  sexual  appetite, 
and  he  was  able  to  pursue  his  studies  with  more  assidu- 
it\^  than  had  previously  been  the  case.  He  made  a 
voyage  to  India,  in  order  to  perfect  himself  in  certain 
branches  of  knowledge  which  he  thought  he  could  not 
study  thoroughly  at  home.  During  his  travels  he  was 
repeatedly  thrown  into  company  with  attractive  women, 
but  he  had  so  thoroughly  conquered  his  sexual  feelings, 
that  they  were  to  him,  as  he  said,  no  more  than  logs  of 
wood.  He  remained  absent  seven  years,  but  had  en- 
tirely abandoned  all  idea  of  forming  a  philosophical 
sect.  Indeed,  his  travels  had  cured  him,  verv  effectu- 
ally, of  a  good  many  absurd  notions  which  he  had  con- 
tracted;   among  t)thcrs,  tiuit  of  perpetual  celil.vicv.     As 


ABSENCE   OF   SEXUAL   DESIRE.  89 

he  was  a  man  of  wealth,  and  his  fondness  for  society 
had  returned,  he  thought  he  would  marry,  but  was  ap- 
prehensive that  he  would  not,  owing  to  his  lengthened 
period  of  continence,  be  able  to  perform  the  part  of  a 
husband  in  the  marriage  relation.  During  the  whole 
time  that  he  had  been  abroad  he  had  had  no  connec- 
tion, no  nocturnal  emissions,  no  lascivious  dreams,  and 
no  erections  based  upon  sexual  desire.  He  had  no 
other  object  in  marrying  than  to  obtain  a  home  and  its 
comforts,  but  would  forego  the  idea  if  he  was  incapable 
of  intercourse. 

Upon  examination  I  found  that  the  genital  organs 
were  of  normal  form  and  condition,  and,  therefore,  that 
no  obstacle,  so  far  as  they  were  concerned,  existed. 
Except  for  his  assurance  that  he  never  experienced 
erections  nor  desire  I  should  have  pronounced  him 
competent,  but,  in  the  face  of  his  declarations,  I  was 
satisfied  that  he  was  suffering  from  mental  impotence, 
and  that  his  cure  would  have  to  be  effected  by  moral 
means.  I  advised  him  to  enter  society,  and  to  try  to 
fix  his  affections  upon  some  virtuous  and  attractive 
woman  whom  he  would  be  satisfied  to  marry,  and  to 
wait  patiently  for  the  re-development  of  his  sexual 
desires.  He  had  no  faith,  however,  in  that  plan  of 
treatment,  but  went  off,  on  his  own  responsibility,  into 
all  kinds  of  attempted  sexual  excesses.  Several  months 
afterward  he  returned,  with  the  information  that  he 
was  actually  and  permanently  impotent.  No  excita- 
tions which  he  had  employed   had  sufficed  to  induce 


90  SEXUAL   IMPOTENCE   IN   THE   MALE. 

in  him  the  shghtest  desire,  and  his  condition,  therefore, 
was  a  great  deal,  worse  than  it  had  been.  He  had 
exhausted  the  means  in  an  irregular  way,  which,  had 
he  followed  my  advice,  would,  there  was  reason  to 
hope,  have  been  gradually  efficacious.  Moreover,  in 
his  attempts  at  intercourse,  he  had  contracted  a 
chancre,  and  was  already  suffering  from  secondary 
manifestations.  He  was  placed  upon  anti-svphilitic 
treatment,  but  soon  afterward  went  to  the  Hot  Springs 
of  Arkansas,  and,  while  in  the  West,  married  a  prosti- 
tute, who  wanted  his  money,  and  who  had  persuaded 
him  she  could  cure  him.  I  believe  he  is  still  living 
somewhere,  but  am  quite  sure  there  has  been  no  return 
of  sexual  desire. 

In  this  case  there  was  a  loss  of  power  as  well  as  oi 
desire,  and  hence  a  double  cause  for  the  impotence 
which  existed.  The  origin,  however,  was  clearly  in 
abolition  of  desire,  the  loss  of  power  being  a  secondary 
phenomenon. 

Treatment. — The  treatment  of  cases  in  which,  from 
any  cause,  the  normal  sexual  desire  of  the  individual 
has  been  lessened  or  abolished  to  such  a  degree  as  to 
render  intercourse  impossible,  has  been  to  a  great  ex^ 
tent  indicated  in  the  preceding  pages,  when  each  case 
has  been  under  consideration.  In  general  terms,  it 
consists  in  the  use  of  the  bromides,  in  those  instances 
in  which  there  has  been  excess  in  anv  unnatural  direc 
tion,  such  as  pederasty,  masturbation,  or  mental  inter 
course  ;   and  in  the  employment  of  such  moral  means  in 


ABSENCE   OF   SEXUAL   DESIRE.  9I 

them  and  in  the  other  classes  of  cases  as  each  particular 
instance  may  seem  to  require.  Roubaud  treated  the 
case  I  have  quoted  from  him  by  requiring  his  patient 
to  take  a  full  dose  of  tincture  of  cantharides,  and  then 
while  under  its  influence  to  attempt  connection  with  a 
dark  woman  who  was  without  corset,  gaiter  boots  and 
a  silk  robe.  The  attempt  failed,  but  the  effect  upon 
the  genital  organs  of  the  patient  was  such  that  he 
begged  for  another  dose,  satisfied  that  at  the  next  ex- 
periment success  would  be  attained.  Fearful  of  excit- 
ing too  intense  a  degree  of  cj'stitis,  Roubaud,  while 
pretending  to  give  him  cantharides  gave  him  a  potion 
free  from  this  substance.  The  expectant  attention  of 
the  patient  was,  however,  so  aroused  that  this  dose  had 
as  strong  an  effect  as  the  other,  and  he  finally  succeeded 
through  the  indirect  influence  (for  it  was  absolutely 
inert),  in  effecting  intercourse  with  a  brunette  without 
a  corset.  The  confidence  of  the  patient,  however,  in 
the  medicine  was  so  great  that  he  was  not  willing  to 
dispense  with  it,  and  though  he  continued  to  have 
sexual  relations  with  dark  women  he  always  took  his 
potion. 

In  the  employment  of  moral  means  or  those  acting 
through  the  mind  of  the  patient,  nothing  is  of  more 
importance  than  to  give  him  confidence  in  himself,  and 
in  the  means  which  may  be  adopted  for  his  relief.  If 
this  point  can  be  secured  the  battle  is  half  won;  without 
it  victory  is  always  doubtful. 

And  again,  great  delicacy  is  generally  required  in  all 


92  SEXUAL   IMPOTENXE   IN   THE   MALE. 

efforts  intended  to  act  through  the  mind  which  may  be 
directed  to  the  re-awakening  of  the  physiological  desire 
for  sexual  intercourse.  In  my  experience  the  society 
of  respectable  women  is  ultimately  more  efficacious 
than  that  of  loose  women  and  prostitutes.  In  cases  of 
simple  loss  of  desire,  the  power  is  not  materiall}^ 
effected :  it  is  the  inclination  alone  which  is  wanting, 
just  as  a  man  may  possess  good  digestive  powers,  and 
yet  have  no  appetite.  Now,  the  sexual  feeling  is  much 
more  apt  to  be  provoked  by  a  woman  impossible  to  be 
obtained  without  marriage  than  by  one  who  can  be 
had  for  the  asking,  or  for  a  sum  of  money.  The 
appetite,  like  that  for  the  good  things  of  the  table,  is 
whetted  by  the  difficulties  that  are  in  the  way,  and 
hence  the  object  is  obtained  by  natural  means  under 
the  regulations  which  law  and  social  life  impose.  Of 
course  there  are  cases,  such  as  some  of  those  described 
in  this  chapter,  for  whom  it  is  impossible  to  recommend 
the  society  of  virtuous  women.  They  are  altogether 
too  infamous  in  habits  and  principles  for  the  physician 
to  think  of  subjecting  decent  women  to  their  companion- 
ship. But  there  are  others  to  whom  this  stigma  is  not 
applicable,  and  who,  but  for  the  refuge  which  the  soci- 
ety of  virtuous  women  is  capable  of  affording,  and  the 
prospect  held  out  of  making  a  marriage,  would  either 
go  over  to  prostitutes  or  ruin  themselves  with  mastur- 
bation or  other  irregular  sexual  practices. 


ABSENCE   OF   THE   POWER   01^   ERECTION.  93 


CHAPTER  11. 

ABSENCE     OF    THE     POWER   OF   ERECTION   AND   OF  CON- 
SEQUENT   INTROMISSION. 

There  are  many  more  cases  of  impotence  met  with 
under  this  head  than  all  others  combined.  It  is  the 
trouble,  therefore,  with  the  great  majority  of  men  who 
consult  a  physician  or  surgeon  in  order  that  their  virile 
powers  may  be  restored  to  them.  No  cause  is,  accord- 
ing to  my  experience,  so  destructive  to  the  happiness 
of  the  average  man  as  the  loss  of  his  virile  power, 
while  his  desire  still  exists  not  measurably  impaired. 
He  may  be  abstinent,  but  at  the  same  time  if  he  dis- 
covers that  he  is  sexually  impotent,  though  he  may  not 
care  to  exercise  his  powers  once  a  month,  his  peace  of 
mind  is  interfered  with  to  an  extent  that  no  other 
disease  is  capable  of  causing. 

In  impotence  arising  from  the  condition  in  question 
there  is  an  impossibility  of  entering  the  vagina  with 
the  male  organ  owing  to  the  fact  that  the  latter  re- 
mains in  a  state  of  flaccidity.  This  state  may  be  the 
result  of  one  or  more  of  several  causes,  of  which  the 
following  are  the  chief: 

Early  Sexual  Excesses. — Perhaps  of  all  the  causes  of 
failure  of  sexual  power  in  adult  life  the  induction  of 
the   sexual   orgasm    during    infancy   or  youth   is   the 


94  SEXUAL   IMPOTENCE   TN   THE    MALE. 

most  frequent.  The  fact  that  voluptuous  sensations 
can  be  excited  in  children  who  are  vet  in  their  nurses' 
arms  is  well  known  to  physicians,  who  are  often  called 
upon  to  treat  affections  of  the  nervous  system  which 
are  the  direct  result  of  such  excitation.  Epilepsy, 
chorea,  and  spinal  diseases,  causing  paralysis,  some- 
times have  this  cause  as  their  factor  and  the  ground- 
work may  be  laid  for  still  more  deplorable  conditions 
which  are  developed  in  after  life.  Into  the  ♦considera- 
tion of  these  effects  it  does  not  come  within  the  scope 
of  this  work  to  enter  or  to  consider  them  at  all  except 
so  far  as  they  relate  to  sexual  impotence. 
'  It  is  a  law  of  the  organism  that  any  function  which 
is  over-exerted  before  the  organs  producing  it  are  fully 
matured  is  certain  to  lead  to  the  derangement  or  even 
extinction  of  that  function.  A  child  whose  brain  is  over- 
taxed by  studies,  which  are  in  advance  of  those  suitable 
for  an  immature  brain,  runs  serious  risks  of  becoming 
epileptic  or  imbecile.  Another,  who  is  set  to  the  per- 
formance of  physical  work  of  too  severe  a  character,  is 
arrested  in  its  growth,  and  becomes  puny  and  feeble ; 
and  it  is  equally  certain  that  a  like  result,  so  far  as 
regards  the  generative  system,  will  follow  on  a  too 
early  excitation  of  the  sexual  organs.  In  very  young 
infants  it  is  sometimes  the  case  that  in  order  to  sooth 
them  nurses  titillate  the  genital  organs  and  thus  pro- 
duce sensations  which  are  agreeable  and  which  are 
subsequently  desired.  Eventually  the  operation  is 
performed  by  the  child,  and,  being  continued  through 


ABSENCE   OF  THE   POWER   OF   ERECTION.  g$ 

the  period  of  puberty,  leads  to  complete  impotence 
from  loss  of  power,  and  often  from  loss  of  desire  also. 

In  such  cases  as  these  the  ordinary  manual  excitation 
of  the  penis  generally  after  a  time  becomes  insufficient  to 
produce  an  emission,  and  various  processes  are  resorted 
to  to  provoke  the  requisite  degree  of  excitability  to 
cause  a  seminal  ejaculation.  From  a  very  early  period 
in  the  history  of  medicine  the  effects  of  early  excesses 
have  been  thoroughly  recognized.  Hippocrates,  in 
speaking  of  the  disease  now  known  as  locomotor  ataxia, 
or  tabes  dorsalis,  says:  * 

"  This  disease  attacks  young  married  people  or  those 
given  to  venereal  excesses.  There  is  no  fever,  and 
although  they  may  eat  a  sufficient  amount  of  food,  they 
become  emaciated.  They  have  sensations  of  ants 
crawling  along  them,  and  every  time  that  they  go  to 
stool  or  urinate  they  lose  a  certain  quantity  of  their 
seminal  fiuid  ;  they  are  incapable  of  generation,  and 
they  often  have  the  sexual  orgasm  in  their  sleep." 

I  cite  this  extract  from  Hippocrates  merely  for  the 
purpose  of  showing  that  he  recognized  the  fact  that 
early  sexual  excesses  lead  to  impotence,  and  not  with 
the  least  intention  of  endorsing  the  rest  of  what  he  has 
said,  much  of  which  is  clearly  incorrect.  This,  how- 
ever, will  engage  our  attention  further  on. 

Celsusf  declares  that  the  pleasures  of  love,  if  indulged 

*  De  Morbis,  Lib.  2,  Cap.  xlix. 
f  De  Re  medica,  Lib.  i,  Cap.  ix. 


96  SEXUAL   IMPOTENCE   IN   THE   MALE. 

in  to  excess,  are  always  injurious  to  weak  persons,  and 
exhaust  the  vital  powers. 

Aretaeus  *  says :  "  Young  people  who  are  excessive 
in  sexual  matters  acquire  the  appearance  and  diseases 
of  the  aged.  They  become  pale,  effeminate,  indisposed 
to  physical  exertion,  stupid  and  even  imbecile.  They 
are  bent  forward,  their  legs  can  no  longer  support 
them,  they  have  a  distaste  for  everything,  they  are 
incapable  of  everything  and  often  they  become  para- 
lytics. 

Tissot,t  among  other  evils  of  masturbation,  calls  atten- 
tion to  the  facts  that  the  organs  of  generation  experience 
a  large  share  of  the  evils  of  which  they  are  the  first  cause. 
Many  patients  become  incapable  of  having  erection,  and 
with  others  the  seminal  fluid  is  discharged  by  the  slight- 
est contact,  and  at  the  least  approach  to  an  erection. 
The  -same  author,  in  referring  to  the  early  initiation 
of  some  children  into  the  vice  of  masturbation,  says : :{; 
"  It  is  proper  to  state  that  onanism  is  particularly 
dangerous  in  the  cases  of  infants,  and  at  any  time  before 
the  age  of  puberty.  Happily,  it  is  not  common  to  find 
monsters  of  either  sex  who  commit  this  outrage  upon 
them,  but  it  is  too  true  that  they  often  commit  it  them- 
selves." Again,  in  reference  to  the  intervention  of  impot- 
ence as  the  result  of  masturbation,  he  lays  special  stress 

*  De  Signis  et  Causarum. 

+  "  L'Onanisme:  Dissertation  sur  les  maladies  produites  par  la  mastur- 
bation."    Paris,  1S05,  p.  21. 
I  Op.  cit.,  p.  81. 


ABSENCE   OF   THE   POWER   OF   ERECTION.  97 

upon  the  fact  that  a  kind  of  paralysis  of  the  organs  of 
generation  is  produced,  and  hence  an  impossibility  of 
procuring  erections. 

Deslandes  *  relative  to  sexual  excesses,  says  :  "  As  a 
final  result  the  sensibility  of  the  generative  organs  may 
be  exhausted  and  may  disappear.  The  manoeuvres, 
which  in  the  beginning  had  led  promptly  to  the  de- 
sired result,  become  incapable  of  reawakening  a  sensa- 
tion, which  little  by  little  has  become  weaker,  and  at 
last  annihilated.  They  may  still  be  able  to  cause  an 
erection  of  the  penis,  and  even  to  produce  a  painful 
state  of  priapism,  but  they  no  longer  cause  the  pleas- 
ure which  they  formerly  induced.  It  would  be  better, 
when  this  kind  of  paralysis  occurs,  that  the  recollection 
of  previous  pleasures  could  be  abolished,  but  it  merci- 
lessly remains,  and  it  is  that  alone  which  prompts  the 
unhappy  individual  to  continue  abuses.  Tormented 
by  this  remembrance,  the  blase  masturbator  provokes 
his  turgid  organs.  Obtaining  no  satisfactory  results  in 
his  methods,  he  invents  new  ones,  which  are  at  the 
same  time  eccentric,  monstrous,  and  horrible.  The 
thoughts  which  he  once  entertained  were  candid  and 
innocent  compared  to  those  which  now  fill  his  mind,  and 
the  onanism  he  once  practiced  is  almost  a  praiseworthy 
act  beside  that  in  which  he  indulges.  The  bare  hand, 
which  formerly  sufficed  to  produce  the  orgasm,  is  no 
longer  competent  to  that  end,  and  the  surface  of  the 

*  "  De  I'onanisme  et  des  autres  abus  veneriens  consider^s  dans  leurs 
rapports  a vec  la  sante."     Paris,  1805,  p.  274. 


98  SEXUAL   IMPOTENCE   IN   THE    MALE. 

penis,  where  previously  the  sensibility  was  situated,  is 
now  exhausted  of  its  capacity  to  yield  pleasure,  and  he 
is  forced  to  seek  it  more  profoundly  where  his  hand 
has  not  yet  reached ;  operations  which  would  have 
formerly  been  regarded  as  causing  tortuie  are  now 
performed  without  hesitation,  at  the  dictation  of  the 
power  within  him.  He  wounds  and  tears  the  parts, 
recoiling  at  nothing,  providing  he  can  be  made  to  feel. 
This  condition  lasts  until  these  dangerous  expedients 
in  their  turn  fail,  either  because  they  eventually  lose 
their  power  or  because  of  the  grave  accidents  which 
they  produce." 

Chopart  relates  the  particulars  of  a  case  which  is  one 
of  the  most  striking  of  the  whole  range  of  the  clinical 
history  of  the  subject,  and  which,  as  showing  the  terri- 
ble extremes  to  which  masturbators  may  go,  is  worth 
citing  in  the  present  connection  : 

A  shepherd  of  Languedoc,  Gabriel  Gallien,  aban- 
doned himself  to  masturbation  at  the  age  of  fifteen,  com- 
mitting the  act  as  many  as  fifteen  times  a  day.  Event- 
ually he  reached  the  point  at  which  ejaculation  rarely 
took  place,  sometimes  continuing  his  efforts  for  an 
hour  before  emission  occurred.  It  often  happened 
to  him  to  go  into  convulsions  while  he  was  perpe- 
trating the  act  of  masturbation,  and  to  emit  a  few 
drops  of  blood  instead  of  semen.  For  eleven  years  he 
used  only  his  hands,  but  at  about  his  twenty-sixth  year, 
not  being  able  to  produce  the  ordinary  sensation  by 
this  means,  he  adopted  the  expedient  of  introducing  a 


ABSENCE   OF   THE    POWER   OF   ERECTION,  99 

piece  of  wood  about  six  inches  long  into  the  urethra 
several  times  every  day.  For  sixteen  years  he  made 
use  of  this  procedure,  but  finally  the  lining  membrane 
of  the  urethra  became  hard,  callous,  and  altogether 
insensible ;  the  piece  of  wood  no  longer  answered  the 
purpose  which  it  had  accomplished ;  he  had  a  contin- 
ual erection  which  nothing  could  dissipate. 

During  all  this  time  he  had  an  insuperable  aversion 
to  women,  a  by  no  means  rare  circumstance  with  mas- 
turbators ;  he  became  melancholic,  neglected  his  work, 
and  thought  only  of  the  means  of  satisfying  his  desires. 
Desperate,  and  attaining  no  success  with  the  many  expe- 
dients to  which  he  had  recourse,  he  one  day  decided  to 
make  an  incision  with  his  knife  through  the  glans  and 
in  the  direction  of  the  urethra.  This  operation,  far 
from  causing  him  pain,  procured  him  an  agreeable  sen- 
sation and  produced  an  abundant  seminal  emission. 
From  that  time,  happy  in  having  made  a  discovery 
which  permitted  him  to  satisfy  his  inclinations,  he  often 
repeated  the  same  experiment,  and  always  with  the 
same  result. 

After  having  performed  this  horrible  mutilation  per- 
haps a  thousand  times,  the  unfortunate  wretch  found 
that  he  had  divided  the  penis  from  the  meatus  to  the 
symphisis  pubis  into  two  equal  parts.  When  h^emor- 
rhage  was  particularly  great,  he  arrested  it  by  tying  a 
cord  around  the  penis.  The  corpora  cavernosa,  sepa- 
rated as  they  were,  were  equally  capable  of  erection, 
but  they  diverged  to  the  right  and  left.     When  the  pe- 


lOO  SEXUAL   IMPOTENCE   IN   THE   MALE. 

nis  was  divided  as  far  as  the  symphisis  the  knife  was 
no  longer  useful,  and  then  there  were  new  provisions, 
new  chagrins,  new  attempts  to  obtain  the  pleasure  he 
craved.  Among  the  expedients  to  which  he  resorted 
was  one  with  a  piece  of  wood  shorter  than  the  one  he 
had  previously  used,  and  which  he  introduced  into  the 
part  of  the  urethra  which  remained  to  him.  He  thus 
succeeded  in  exciting  the  very  orifices  of  the  ejacula- 
tory  ducts  and  in  causing  an  emission  of  semen.  For 
ten  years  this  procedure  satisfied  him,  until  one  day  he 
was  so  careless  in  the  use  of  his  stick  of  wood  that  it 
escaped  from  his  fingers  and  slipped  into  his  bladder. 
At  once  he  experienced  great  pain,  and  all  the  efforts 
he  made  to  expel  the  foreign  body  were  without  suc- 
cess. Finally,  after  intense  suffering  from  retention  of 
urine  and  haemorrhage  from  the  bladder,  he  consulted 
a  surgeon,  who  was  of  course  greatly  astonished  to 
find,  instead  of  a  single  penis,  two,  each  as  large  as  the 
original.  The  great  pain  felt  by  the  patient  decided 
the  surgeon  to  perform  the  operation  of  lithotomy, 
which  having  done  he  extracted  the  piece  of  wood — 
which  from  having  been  three  months  in  the  bladder 
was  deeply  incrusted  with  calcareous  matter.  After 
some  serious  drawbacks  the  patient  recovered  from 
the  operation,  but  died  about  three  months  subsequently 
of  phthisis,  due  to  his  long-continued  and  frequently 
repeated  excesses. 

Other  cases  have  been  recorded  in  which  wounds 
have  been  inflicted  for  the  purpose  of  re-exciting  an 


ABSENCE   OF  THE   POWER   OF   ERECTION.  lOI 

organ  whose  excitability  to  the  ordinary  stimulus  was 
exhausted,  but  none  on  record  equal  this  remarkable 
instance  of  the  French  shepherd.  It  is,  however,  from 
the  more  common  examples  that  the  greatest  amount 
of  knowledge  is  to  be  obtained  and  the  proper  deduc- 
tions drawn ;  and  hence  the  relation  of  a  few  additional 
ones,  as  recorded  by  others,  and  one  or  two  from  my 
own  experience,  will  not  be  out  of  place  in  the  present 
connection. 

Deslandes  refers  to  the  case  of  a  school  teacher, 
who  titillated  the  urethra  by  foreign  bodies  in  order 
to  obtain  an  emission.  He  generally  used  an  iron 
wire,  which  he  took  the  precaution  to  bend  over  at 
the  end,  so  as  to  form  a  hook  and  thus  avoid  injury 
as  far  as  possible  to  the  lining  membrane.  One  day, 
while  engaged  in  the  use  of  this  instrument,  and  being 
a  little  more  excited  in  his  movements  than  usual,  the 
hook  caught  in  the  wall  of  the  canal  and  could  not  be 
withdrawn.  He  made  many  attempts,  all  of  which 
failed ;  but  still,  notwithstanding  his  sufferings,  shame 
prevented  him  from  applying  to  a  surgeon.  He  bent 
the  distal  end  of  the  wire  into  the  form  of  a  ring  so  as 
to  be  able  to  exercise  greater  traction,  but  still  he 
could  not  succeed,  and  in  the  midst  of  his  exertions  the 
ring  was  pulled  off  and  the  wire  remained  in  the  ure- 
thra. Driven  then  to  despair  and  fearing  death,  he  ap- 
plied to  a  surgeon,  Monsieur  Fardeau,  of  Saumur. 

The  penis  was  found  to  be  enormously  swollen,  as  was 
also  the  skin  of  the  scrotum.     All  the  tissues  which  are 


102  SEXUAL   IMPOTENCE   IN   THE   MALE. 

found  at  the  point  of  insertion  of  the  penis  to  the  pubis 
were  also  in  a  state  of  great  tumefacation,  hot  and  pain- 
ful. The  abdomen  was  beginning  to  be  tympanitic, 
there  was  a  suppression  of  urine,  the  countenance  was 
ruddy  and  the  eyes  suffused,  the  mind  was  beginning 
to  wander,  the  pulse  was  hard,  frequent,  and  small. 
Monsieur  Fardeau  took  hold  of  the  projecting  wire, 
and,  making  traction  on  it,  became  satisfied  that  the 
other  end  was  fast  to  some  solid  substance.  Exploring 
the  part  with  the  greatest  circumspection,  he  was  not 
surprised  to  find  that  the  hook  was  fixed  in  the  internal 
border  of  the  tuberosity  of  the  ischium.  An  incision 
was  made  in  this  region,  the  hook  was  seen,  and  the 
wire  was  extracted  by  the  perineum.  The  patient  was 
at  once  relieved,  and  his  health  was  completely  re-es- 
tablished. 

M.  Saraill6  *  reports  the  case  of  a  man  fifty  years 
old,  who  for  three  years  had  masturbated  with  a  darning- 
needle,  which  he  introduced  into  the  urethra.  One  day 
while  using  it,  it  escaped  from  his  fingers  and  disap- 
peared within  the  canal.  Eight  days  afterwards  it  was 
extracted  by  an  operation,  after  the  patient  had  under- 
gone much  suffering. 

Several  cases  in  which  masturbation  by  the  urethra, 
when  the  excitation  of  the  glans  no  longer  sufficed  to 
produce  the  orgasm,  have  come  under  my  notice.  In 
all  the  act  had  been  begun  at  an  early  age,  and  had 
been  frequently  performed  daily  before  the  sensibility 

*"  Journal  de  med.,  chir.  et  pharm.,"  t.  xxviii.  p.  290. 


ABSENCE   OF   THE   POWER   OF   ERECTION,  103 

of  the  glans  was  lost.  In  one  of  these  instances  the 
patient,  a  young  man  twenty-three  years  of  age,  had 
practised  masturbation  excessively  from  the  time  that 
he  was  nine  years  old.  At  about  his  fifteenth  year  the 
sensibility  of  the  glans  was  nearly  extinct,  and,  though 
emissions  could  be  produced,  the  voluptuous  sensations 
were  almost  nothing,  and  erection  was  very  imperfect. 
He  then  began  to  make  use  of  a  penholder  made  of 
hard  rubber,  which  he  introduced  to  the  extent  of  two 
or  three  inches  into  the  urethra.  In  the  course  of 
three  or  four  years  this  resource  began  to  fail  him. 
The  lining  membrane  had  also  lost  its  sensibility,  and 
had  become  thick  and  dense.  He  then  procured  a 
No.  3  gum-elastic  catheter,  which,  being  of  less  di- 
ameter than  the  penholder,  admitted  of  being  more 
readily  introduced.  This  sufficed  for  several  years,  but 
eventually  it  also  lost  its  power.  During  all  this  time, 
although  he  continued  to  work  at  his  trade,  that  of 
plumbing,  he  suffered  from  many  forms  of  derangement 
of  his  nervous  system,  such  as  headache,  tremor,  dim- 
ness of  sight,  deafness,  and  neuralgic  pains  in  various 
parts  of  his  body.  He  had  never  had  sexual  inter- 
course, and  was  altogether  incapable  of  the  act.  At 
times  he  would  suffer  from  violent  erections,  accompa- 
nied by  intense  pain  in  the  genital  organs  and  in  the 
back,  and  occasionally  by  wandering  of  the  mind  ;  and 
in  the  course  of  ten  or  more  hours  these  would  be  re- 
lieved by  an  emission  of  semen,  usuall}^  during  the 
night,  and  without  the  accompaniment  of  a  dream  or 


104  SEXUAL   IMPOTENCE   IN   THE    MALE. 

any  voluptuous  sensation.  For  this  condition  he  had 
consulted  a  surgeon,  who  had  cauterized  the  spine  with 
a  white-hot  iron,  and  given  him  the  bromide  of  potas- 
eium,  both  very  proper  means.  Finally,  under  the 
continued  use  of  the  bromide,  he  was  greatly  relieved. 
He  had  not  recovered  his  virile  power  when  he  came 
under  my  notice.  The  penis  was  very  small,  and  had 
not,  so  he  informed  me,  been  in  the  state  of  erection 
for  over  five  years,  not  even  the  merely  physical 
erection  due  to  lying  on  the  back  or  to  an  over-dis- 
tended bladder.  He  had  now^  become  a  master  plum- 
ber and  was  anxious  to  marry,  and  it  was  for  the  cure 
of  his  impotence  that  he  came  under  my  care.  It  may 
suffice  now  to  say,  what  will  be  dwelt  upon  at  greater 
length  hereafter,  that  he  regained  a  sufficient  degree 
of  sexual  power  to  admit  of  his  marrying  and  having 
connection. 

In  another  case  the  termination  was  not  so  fortunate. 
In  this  instance  the  patient  had  masturbated  as  far  back 
as  he  could  recollect,  and  when  quite  an  infant  was 
used  by  his  nurse,  a  mulatto  woman,  to  satisfy  her 
sexual  desires ;  frequently  he  would  procure  the  org- 
asm a  dozen  or  more  times  in  the  day,  but  after  the 
age  of  puberty,  when  seminal  emissions  began  to  oc- 
cur, he  did  not  practice  the  act  so  often.  He  never, 
however,  that  he  could  recollect,  went  a  whole  day 
without  masturbating  two  or  three  times. 

At  the  age  of  twenty-one  he  was  still  practising  the 
act,  though   with  very  little  satisfaction,  for  the  erec- 


ABSENCE   OF   THE    POWER   OF   ERECTION.  I05 

tions  were  very  feeble,  and  the  emissions  scarcely 
caused  the  faintest  voluptuous  feeling.  He  began  now 
to  make  experiments  with  himself,  and  at  once  obtained 
an  increase  of  pleasure  from  the  use  of  a  hair  glove 
which  he  wore,  and  which  by  its  roughness  served  to 
produce  a  sufficient  amount  of  sensibility  in  the  glans ; 
but  finally  this  failed,  as  in  their  turn  all  devices  do 
under  such  circumstances,  and  he  was  at  a  loss  how  to 
obtain  the  pleasure  which  was  a  craving  night  and 
day. 

At  last  he  thought  it  would  answer  the  purpose  if  he 
lubricated  his  hand  with  strong  ammoniacal  liniment. 
He  at  once  acted  upon  the  suggestion,  and  finding  it 
to  be  successful,  adopted  the  plan,  generally,  however, 
being  obhged  to  increase  the  strength  of  the  liniment 
by  adding  an  additional  quantity  of  ammonia  to  it. 
The  sensation  produced  upon  the  glans  penis  by  this 
agent,  so  far  from  being  painful,  was  the  chief  source 
of  his  pleasure,  but  the  local  effects  were  such  as  to 
cause  him  a  certain  degree  of  anxiety.  Inflammation 
attended  with  great  swelling  and  redness  set  in  from 
the  first,  and  every  time  that  he  employed  the  applica- 
tion the  manifestations  of  serious  disturbance  became 
more  marked,  and  they  were  not  by  any  means  limited 
to  the  penis,  for  there  were  a  high  degree  of  fever  and 
more  or  less  mental  implication,  consisting  of  hallucina- 
tions both  of  sight  and  hearing.  At  last  a  large  ulcer 
was  produced,  which  involved  the  whole  of  the  anterior 
surface  of  the  glans,  and  which  ultimately  resulted  in 


I06  SEXUAL   IMPOTENCE   IX   THE   MALE. 

the  sloughing  of  the  prepuce,  and  of  a  considerable  por- 
tion of  the  glans.  The  production  of  the  orgasm,  by 
some  means  or  other,  had,  however,  become  absolutely 
necessary  to  him,  and  notwithstanding  the  fact  that  a 
gangrenous  ulcer  included  more  than  one  third  of  the 
penis  he  continued  to  apply  strong  ammonia  to  the  raw 
surface  and  to  obtain  pleasure  from  the  act. 

Hitherto  he  had  managed  to  keep  his  proceedings  a 
secret  from  his  family ;  but  about  this  time  exposure 
took  place  from  spots  of  blood  and  pus  being  observed 
on  his  linen,  and  which  he  had  forgotten  to  wash  off. 
On  being  detected  he  made  a  full  avowal  to  his  father 
and  with  much  apparent  contrition  and  mental  suffer- 
ing begged  that  he  might  be  cured  of  his  infatuation. 
He  left  his  home  in  company  with  his  father  to  place 
himself  under  my  care.  At  Fall  River  he  got  on  board 
the  steamboat  that  was  just  about  to  leave  for  New 
York,  and  at  his  request  had  a  state-room  apart  from 
that  of  his  father  assigned  him,  pleading  in  excuse  that 
the  odor  from  his  ulcer  was  such  as  to  render  it  impos- 
sible for  his  father  to  be  in  close  quarters  with  him 
without  being  rendered  very  uncomfortable.  He 
pledged  himself  not  to  attempt  masturbation.  He 
entered  the  room  at  about  nine  o'clock  at  night,  and 
that  was  the  last  that  has  ever  been  seen  of  him.  In 
the  morning  the  room  was  found  empty,  the  bed  not 
having  been  occupied.  It  was  supposed  by  his  father, 
who  gave  me  the  foregoing  details,  that  he  repeated 
the  act  of  masturbation,  and  that,  filled  with  remorse,  he 


ABSENCE   OF   THE   POWER   OF   ERECTION.  10/ 

had  thrown  himself  into  the  water.  During  his  whole 
life  he  had  always  manifested  the  most  intense  distaste 
for  the  society  of  women,  and  had  informed  his  father 
that  he  had  never  felt  the  slightest  desire  for  sexual 
intercourse. 

Of  course  the  earlier  sexual  excesses  are  initiated, 
the  greater  is  the  probability  that  impotence  will  be 
the  result  in  after-life.  It  it  very  certain  that  there  is 
a  much  greater  precocity  in  this  respect  even  among 
civilized  nations  than  is  probably  believed,  but  which 
a  little  reflection  will  suffice  to  convince  one  does  really 
exist.  The  practice  which  prevails  among  the  very 
poorest  classes,  of  men,  women,  and  children  occupying 
the  same  room,  and  not  infrequently  the  same  bed, 
irresistibly  leads  to  an  undue  and  early  development 
of  the  sexual  appetite.  I  have  myself  seen  in  the  city 
of  New  York,  boys  and  girls  three  or  four  years  of  age 
attempt  intercourse  in  the  manner  in  which  the}^  had 
seen  their  elders  perform  it,  and  this  without  the  slight- 
est idea  that  they  were  doing  anything  wrong,  and  in 
the  very  presence  of  their  fathers  and  mothers,  without 
any  other  reprimand  than  a  laughing  rebuke.  In  New 
Mexico,  I  have  seen  the  like  attempts  made  in  the 
streets,  and  with  the  applause  and  encouragement  of 
men  and  women.  Acts  of  masturbation  by  mere  chil- 
dren were  at  the  time  of  which  I  speak,  thirty  years 
ago,  commonly  practised  in  the  presence  of  adults  with- 
out even  attracting  attention.  The  men  of  that  Terri- 
tory were  noted  for  their  impotence,  and  were  often 


I08  SEXUAL   IMPOTENCE   IN   THE    MALE. 

subjects  of  incantations  and  Other  superstitious  rites  per- 
formed by  old  women  who  had  the  reputation  of  being- 
able  to  cure  the  affliction  in  question.  Many  of  them 
came  under  my  own  immediate  observation,  but  instead 
of  attributing  the  condition  to  its  real  cause  they  always 
charged  it  to  some  enemy  acting  through  witchcraft, 
or  to  the  direct  agency  of  the  devil. 

Godard  *  states  that  in  Cairo  he  was  informed  that  a 
little  girl  of  six  and  a  boy  of  five  years  of  age  had  been 
seen  in  the  act  of  sexual  intercourse  in  the  street,  and 
that  sometimes  girls  of  three  or  four  years  old  called  to 
boys  in  the  street  to  have  sexual  relations  with  them. 
It  is  not  a  subject  for  surprise,  therefore,  that  precocity 
like  this  and  other  sexual  excesses  to  which  they  are 
addicted  render  the  men  of  the  country  impotent  at  an 
early  period  of  their  lives. 

Relative  to  the  question  whether  masturbation  or 
sexual  intercourse  is  more  readily  productive  of  impo- 
tence, different  opinions  have  prevailed,  but  I  think  there 
can  be  no  reasonable  doubt  that  the  first  is  more  influ- 
ential in  bringing  about  the  condition  in  question.  This 
is  not  because  it  is  in  inself,  so  fas  as  seminal  loss  is 
concerned,  any  more  injurious,  but  for  other  reasons 
which  I  will  proceed  to  state  with  as  much  succinctness 
as  possible. 

In  the  first  place,  the  facilities  for  the  performance  of 


*  "  Egypt  et  Palestine.    Observations  m6dicales  et  scientifiques."  Paris, 
j£67,  page  88. 


ABSENCE   OF   THE    POWER    OF   ERECTION.  IO9 

masturbation  are  always  to  be  obtained,  and  hence  it 
allows  of  more  frequent  repetition  than  does  sexual  inter- 
course. The  masturbator  is  always  ready.  He  has 
only  to  retire  to  privacy  for  a  few  minutes  and  the  act 
is  accomplished.  He  can  if  he  choose  pollute  himself 
a  hundred  or  more  times  a  day,  and  hence  produce  a 
degree  of  exhaustion  impracticable  if  he  restricted 
his  acts  to  intercourse  with  women.  If  women  were 
at  his  command,  and  he  practiced  copulation  as  fre- 
quently as  he  often  does  masturbation,  there  would  be 
no  difference  so  far  as  the  orgasm  and  emission  of  semen 
are  concerned.  Indeed,  the  sexual  act,  as  requiring  a 
greater  expenditure  of  muscular  force  not  requisite  in 
masturbation,  would  probably  be  the  more  injurious  of 
the  two.  So  far  as  relates  to  the  orgasm  and  the  semi- 
nal loss,  it  is  a  matter  of  no  physiological  or  pathological 
importance  where  the  semen  is  deposited,  whether  in 
the  vagina  of  a  woman,  or  in  any  other  receptacle.  It 
is  the  frequency  of  the  act  which  tells  so  greatly  as  a 
factor  for  the  destructive  results  in  masturbation  in 
comparison  with  those  due  to  sexual  intercourse. 

Thus  a  young  man  who  found  himself  impotent  at  the 
age^  of  twenty-two  informed  me  that  he  had  began  to 
masturbate  at  the  age  of  nine,  and  had  often  performed 
the  act  ten  or  a  dozen  times  a  day  for  a  month  at  a 
time.  Such  indulgence  in  sexual  intercourse  would 
be  impracticable  in  any  civilized  country.  Perhaps  in 
Turkey  and  other  eastern  countries,  where  large  harems 
are  kept,  there  would  be  no  difficulty  about  the  matter, 


no  SEXUAL   IMPOTENCE   IN   THE    MALE. 

but  certainly  it  would  be  impossible  in  London,  Paris 
or  New  York,  notwithstanding  the  facilities  which  these 
and  other  large  cities  afford  for  forming  sexual  relations 
with  women. 

For  this  reason,  mainly,  it  is  that  most  of  the  cases 
of  impotence  which  medical  men  have  to  treat  are  the 
result  of  excessive  and  premature  indulgence  in  mastur- 
bation rather  than  in  sexual  intercourse. 

The  effect  of  masturbation  in  causing  impotence  is 
greater  than  that  of  sexual  intercourse  for  the  reason 
that  in  the  former  the  mind  is  more  strongly  brought 
in  to  assist  in  the  production  of  the  orgasm  than  it  is 
in  the  latter.  The  mere  act  of  friction  on  the  glans 
does  not  suffice  to  produce  in  the  masturbator  the 
necessary  degree  of  venereal  excitement.  He  forms 
various  lascivious  images  in  his  imagination,  and  has 
them  vividly  before  him  while  performing  the  act.  The 
consequence  is  that  after  a  time  the  normal  excitation 
of  contact  with  the  female  generative  organs  does  not 
provoke  the  orgasm.  The  reality  is  so  far  below  what 
he  has  frequently  pictured  to  himself  while  masturbat- 
ing that  it  is  insufficient.  He  soon  finds  this  out,  and 
therefore  often  renounces  the  allurements  of  women, 
and  devotes  himself  exclusively  to  his  pernicious  habit, 
from  which,  for  a  time  at  least,  and  a  long  time  if  he  is 
temperate  in  the  indulgence,  he  is  certain  to  obtain  the 
voluptuous  sensations  of  which  he  is  in  search. 

Examples  of  this  fact  are  constantly  coming  under 
the  care  of  the  physician  or  surgeon.     Men  who  have 


ABSENCE   OF  THE   POWER   OF   ERECTION.  Ill 

for  many  years  practised  masturbation  in  moderation, 
and  without  any  notable  impairment  of  their  general 
health,  find  themselves  nearly  entirely  impotent  in  the 
marriage-bed.  Such  cases  are  especially  apt  to  be  met 
with  in  the  persons  of  young  men  of  strong  passions, 
which  they  have  been  obliged  to  control  either  from 
the  force  of  surrounding  circumstances  or  because  of 
their  own  sense  of  propriety  so  far  as  women  are  con- 
cerned, but  who  see  no  impropriety  or  loss  of  self-respect 
in  the  act  of  masturbation ;  or  if  they  do,  are  too  weak 
to  resist  the  temptation.  Such  men  when  they  marry 
find  that  sexual  intercourse  is  far  from  satisfying  their 
desire,  and  moreover,  that  it  is  less  excitant  of  the  gene- 
sic  feeling  than  the  habit  in  which  they  have  indulged. 
They  avoid  it,  therefore,  and  practise  in  secret  the  vice 
to  which  they  are  devoted,  or  give  themselves  up  to 
conjugal  onanism  in  its  various  forms,  a  practice  fully 
as  bad,  if  not  worse  for  him,  besides  being  unsatisfying, 
unnatural,  and  demoralizing  to  another  being. 

Cases  of  this  kind  are  especially  frequent  among 
students  and  other  young  men,  who  practise  mastur- 
bation in  early  life,  ignorant  that  they  are  injuring 
themselves,  who  subsequently  discover  their  error,  and 
who  then  make  a  determined  and  sometimes  successful 
effort  to  overcome  the  habit.  More  frequently  they 
only  partially  succeed,  and  continue  the  vice  filled  with 
remorse  after  each  performance,  vowing  never  again  to 
indulge.  Such  persons  are  generally  impressionable, 
and  endowed  with  a  high  imagination  besides ;  and  yet 


112       SEXUAL  IMPOTENCE  IN  THE  MALE. 

are  from  these  facts  particularly  liable  to  continue  mas- 
turbation  up  to  the  period  of  their  marriage.  The  idea 
of  sexual  intercourse  with  a  lewd  woman  is  offensive  to 
them,  an  exalted  feeling  of  erotism  governs  them,  and 
they  look  forwara  to  the  time  when  they  can  marry 
and  indulge  their  passion  with  a  woman  for  whom  they 
would  entertain  a  sincere  affection.  Meanwhile  they 
continue  to  masturbate,  imagining  to  themselves  that 
they  are  realizing  the  dreams  they  have  long  experi- 
enced.  At  length  they  marry,  and  to  their  extreme 
distress  and  surprise  find  that  they  are  nearly  or  quite 
impotent,  and  that  the  material  blessing  which  has 
been  conferred  upon  them  in  the  love  of  a  pure  woman 
whom  they  love  in  return  is  not  what  they  were  led  to 
expect.  The  anticipation  has  been  greater  than  the 
reality.  Fortunately  such  cases  are  not  usually  difficult 
ones  to  manage. 

Thus  a  young  theological  student  who  began  mastur- 
bation at  school  when  twelve  years  of  age,  continued 
it  up  to  his  fifteenth  year,  when  becoming  aware  of  its 
deleterious  effects  he  endeavored  to  stop.  Previously 
he  had  indulged  not  over  twice  a  day,  but  this  for  a 
person  of  his  age  (or  even  one  of  any  age)  was  pernicious 
excess.  After  his  determination  he  succeeded  in  reduc- 
ing the  number  to  about  one  in  a  week,  but  in  the  mean- 
time he  was  troubled  with  repeated  nocturnal  emissions. 
Some  one  to  whom  he  communicated  the  fact  of  the 
emissions  told  him  that  they  occurred  in  consequence 
of  the  sudden  decrease  in  the  number  of  acts  of  mastur- 


ABSENCE   OF   THE   POWER   OF   ERECTION.  II3 

bation,  and  that  they  were  much  more  injurious.  He 
therefore  resumed  the  practice,  and  upon  several  occa- 
sions indulged  as  often  as  eight  or  more  times  a  day. 
It  was  no  uncommon  thing  for  him  to  have  the  orgasm 
three  times  without  ceasing  his  manoeuvres.  In 
these  exercises  he  always  had  in  his  mind  an  ideal,  a 
lovely  woman  with  light  hair  and  blue  eyes,  one  who 
exhibited  towards  him  the  most  ardent  affection. 
Things  went  on  in  this  way  till  his  eighteenth  year, 
when  he  again  made  an  effort  to  stop,  and  this  time  he 
succeeded  better  than  on  the  former  occasion.  He 
now  left  college,  and  being  religiously  inclined,  began 
the  study  of  theology  with  the  view  of  entering  the 
ministry.  Entering  a  theological  seminary,  he  devoted 
himself  to  hard  study,  and  had  obtained  so  great  a 
mastery  over  himself  that  he  had  not  practised  mastur- 
bation for  over  a  year.  He  was,  however,  greatly 
troubled  with  nocturnal  emissions  three  or  four  times  a 
week  at  least,  and  for  many  weeks  in  succession  as 
often  as  every  night.  There  were  many  occasions  in 
which  he  had  two  m  a  single  night. 

In  consequence  of  all  this  he  fell  into  a  condition  of 
great  nervous  prostration,  in  which  the  chief  feature 
was  cerebral  hyperasmia,  and  which  was  further  charac- 
terized by  wakefulness,  pain  in  the  head,  twitching  of 
the  muscles  of  the  face,  noises  such  as  roaring  and  hiss- 
ing in  the  ears,  and  an  inability  to  concentrate  his  mind 
on  the  subjects  of  his  study.  At  night  his  condition 
was  particularly  distressing,  for  he  was  afraid  to  go  to 


114  SEXUAL   IMPOTENCE   IN   THE    MALE. 

sleep  even  when  towards  morning  he  felt  sleepy,  lest  he 
should  have  a  seminal  emission.     In  sheer  desperation 
he  had  while  awake  in  the  long  hours  of  the  night  mas- 
turbated  several   times,  one  after  the  other,  and  then 
met  with  a  degree  of  mental  composure  which  other- 
wise was  never  present.     It  really  seemed  to  him  as 
though  the  act  of  self-pollution  was,  after  all,  the  only 
thing  that  gave  him  relief,  and  but  for  the  consciousness 
that  he  was  doing  wrong  and  the  inevitable  feeling  of 
remorse    which  tormented  him  the  following  day,  he 
would  have  given  himself  up  without  restraint  to  the 
deleterious  habit.     In  all  these  acts  and  in  all  the  lasci- 
vious dreams  which  accompanied  the  emissions  at  night 
it  was  always  a  lovely,  pure  and  rehgious  woman  with 
light  hair  and  blue  eyes  with  whom  the  intercourse  in 
imagination  took  place.     Finally,  after  continuance  of 
the  condition  for  nearly  four  years,  during  which  period 
he  was  several   times  on   the  point  of  renouncing  his 
intention  of  entering  the  ministry,  he  took  orders,  and 
settled  down  in  charge  of  a  country  parish,  unfit  either 
mentally  or  physically  for  the  duties  he  had  assumed. 
But  he  began  to  find  that  it  was  indispensable  for  his 
usefulness,  and  he  was  much  disposed  to  think  for  his 
health  also,  that  he  should  marry.     He  had  never  in  his 
life  had  sexual  intercourse,  and  had  never  experienced 
the    erotic   manifestations    which  some   young  men  of 
vigorous  health  and  strong  sexual  power  are  apt  to  feel 
when  thrown  into  intimate  relation  with  women.     Still 
he  had  no  reason,  so  far  as  he  could  determine,  to  sus- 


ABSENCE   OF   THE   POWER   OF   ERECTION.  II5 

pect  the  existence  of  any  inability  to  enter  the  marriage 
state,  and  as  there  was  a  young-  lady  in  his  congregation 
who  very  nearly  fulfilled  all  the  requirements  of  his 
masturbatory  imaginings  and  his  lascivious  dreams 
which  accompanied  nocturnal  emissions,  he  resolved  to 
propose  for  her  both  as  a  measure  of  feeling — for  he  was 
much  attached  to  her — as  well  as  of  expediency.  He 
did  so,  was  accepted,  and  the  marriage  in  due  time  took 
place.  The  first  night  was  passed  at  a  hotel  in  the  city 
of  New  York,  and  the  next  morning  the  young  husband 
called  upon  me  in  utter  despair  and  with  the  information 
that  he  was  impotent. 

At  first  I  thought  his  was  one  of  those  cases  so 
frequently  met  with  in  young  married  men,  in  which 
there  is  temporary  impotence  from  mere  excess  of  de- 
sire or  want  of  confidence,  and  which  disappears  in  a 
few  days  under  the  use  of  some  placebo  ;  but  further  in- 
quiry, which  resulted  in  the  elicitation  of  the  historyjust 
given,  convinced  me  that  a  much  more  serious  instance 
of  genesic  disturbance  existed.  I  was  satisfied  that 
there  was  a  state  of  great  sexual  debility  present,  which 
was  the  direct  result  of  the  excesses  he  had  commit- 
ted. Continual  questioning  led  to  the  information  that 
his  desire  had  been  moderately  great,  but  that  his  sexual 
power  had  been  utterly  wanting.  There  had  been  no 
erection,  or  any  approach  to  one,  and  the  result  was 
that  after  many  attempts  at  intercourse  in  the  expectation 
that  success  would  attend  the  efforts,  he  had  desisted, 
had  gone  to  sleep,  and  during  the  night  had  had  two 


Il6       SEXUAL  IMPOTENCE  IN  THE  MALE. 

seminal  emissions.  In  the  morning  the  attempts  were 
renewed,  and  again  without  success. 

In  this  case  there  was  no  mental  trouble,  no  senti- 
mental idea  to  be  fulfilled,  no  intercurrent  thought 
rushing  through  his  mind  and  abolishing  all  desire.  So 
far  as  the  mind  went  there  was  nothing  except  that  he 
had  to  admit  that  the  real  woman  lying  by  his  side  was 
incapable  of  causing  the  same  degree  of  sexual  excite- 
ment as  had  attended  his  mental  images  awake  and 
asleep.  As  a  strongly  sapid  substance  destroys  the 
perception  of  the  tongue  for  delicate  flavors,  so  the 
vivnd  images  which  had  hitherto  filled  his  mind  had 
rendered  the  normal  physiological  stimulus  of  no  avail, 
and  in  addition  there  was  the  loss  of  power  consequent 
on  excess,  a  result  which  is  perhaps  more  clearly  mani- 
fested in  regard  to  the  organs  of  reproduction  than 
those  concerned  with  any  other  function  of  the  bod3\ 

The  case  was  certainly  a  very  unpromising  one,  but  as 
the  physical  examination  showed  that  the  organs  them- 
selves were  in  good  condition,  I  could  not  make  up  my 
mind  that  is  was  hopeless.  I  advised  that  he  should  at 
once  occupy  a  separate  room  from  that  of  his  wife,  that 
for  the  present  no  further  attempts  at  sexual  intercourse 
should  be  made,  and  that  he  should  stay  in  New  York 
about  a  month  for  the  purpose  of  receiving  such  local 
and  other  treatment  as  his  case  required.  This  was,  he 
declared,  impossible,  and  he  accordingly  took  his  leave 
disgusted  with  himself  for  the  hapless  condition  into 
which  he  had  fallen  and  with  me  and  the  science  of 


ABSENCE   OF  THE   POWER   OF   ERECTION.  11/ 

medicine  that  he  could  not  be  cured  in   twenty-four 
hours. 

But  on  the  fifth  day  he  returned,  having  in  the  mean 
time  utterly  failed  to  consummate  the  marriage,  and 
ready  to  agree  to  any  terms  that  I  might  impose  which 
were  at  all  likely  to  result  in  a  restoration  to  sound 
sexual  health.  On  my  certificate  that  he  was  affected 
with  a  serious  disorder  of  his  nervovs  system,  which 
required  treatment,  he  readily  procured  a  leave  of  ab- 
sence from  his  congregation,  and  then  he  put  himself 
definitely  under  my  care.  He  and  his  wife  occupied 
separate  rooms  in  the  hotel  at  which  they  stopped,  and 
he  pledged  his  honor  that  on  no  account  would  he  at- 
tempt sexual  intercourse  till  I  gave  him  permission. 

The  first  thing  to  do  was  to  arrest  the  nocturnal 
emissions,  of  which  he  had  had  one,  sometimes,  more 
every  night  since  his  marriage.  To  this  end  I  pro- 
hibited sleeping  on  the  back,  and  enjoined  the  use, 
morning  and  night,  of  cold  baths,  with  friction  of  the 
whole  body  after  each  with  coarse  towels.  He  was 
also  to  walk  at  least  five  miles  every  day,  and  to  go  to 
some  place  of  amusement  of  a  cheerful  character  every 
evening.  Internally  his  food  was  to  be  of  a  highly 
nutritious  character,  of  which  fat  in  some  form  or 
other,  preferably  cream,  was  to  constitute  a  large  pro- 
portion. His  dinner  was  to  be  taken  not  later  than  two 
o'clock  and  a  couple  of  glasses  of  Burgundy  were  to  be 
drunk  with  it.  For  medicine  I  prescribed  the  follow- 
ing: 


Il8  SEXUAL   IMPOTENCE   IN   THE    MALE. 

5   Sodii  bromidi ^  i. 

Pepsin  (Fairchild's). 

Pancreatin  (Fairchild's) aS  3  iss. 

Glycerinae. 

Aquse aa  5  ii. 

M.  Dose,  a  teaspoonful  in  a  little  sugar  and  water  three  times  a  day 
after  meals- 

My  objects  in  giving  this  mixture  were  to  lessen  the 
reflex  and  automatic  excitability  of  the  generative  sys- 
tem, to  relieve  the  cerebral  hyperasmia,  and  to  promote 
the  digestion  of  food. 

At  bed-time  he  took  a  capsule  of  five  grains  of  the 
monobromide  of  camDhor. 

Every  morning  I  applied  statical  electricity  to  the 
penis  and  testicles,  and  to  the  whole  length  of  the  spinal 
cord,  drawing  inch  sparks  from  the  former  organs,  and 
from  three  to  four  inch  sparks  from  the  spine.  This 
was  continued  for  about  fifteen  minutes.  Though  pain- 
ful the  effect  was  all  that  could  be  desired :  the  blood- 
vessels of  the  penis  became  visibly  distended,  and  the 
whole  organ  assumed  a  deeper  red  color  than  it  had 
possessed,  as  he  said,  within  his  recollection.  For 
several  hours  afterwards  a  warm  pleasant  glow  was  felt 
in  the  penis  and  scrotum. 

Twice  a  week  I  applied  by  means  of  a  urethral 
electrode  a  galvanic  current  from  eight  cells  to  the 
membranous  and  prostatic  portions  of  the  urethra,  with 
the  object  of  diminishing  the  morbid  excitability  which 
evidently  existed  in  those  parts.  I  may  say  that  examina- 
tion with  the  sound  had  previously  demonstrated  the 


ABSENCE   OF   THE   POWER   OF    ERECTION.  1 19 

hypersesthectic  condition  of  the  parts  in  question.  I  had 
at  first  thought  of  cauterizing  them  with  Lallemand's 
instrument,  but  decided  upon  the  galvanism  as  being 
the  less  painful  and  equally  or  more  efficacious.  In 
very  severe  cases,  however,  Lallemand's  procedure  is 
preferable. 

Under  this  system  of  treatment  the  general  health  of 
the  patient  began  to  improve  from  the  first.  The  noc- 
turnal emissions  ceased  entirely  on  the  fifth  night.  On 
the  first  night  he  had  one,  but  without  a  dream ;  on 
the  second,  two  ;  on  the  third,  none;  on  the  fourth,  one  ; 
on  the  fifth,  none,  and  there  were  no  more  while  he  was 
under  my  observation. 

On  every  night  after  the  second  he  slept  for  from  six 
to  eight  hours,  and  in  the  morning  he  awoke  refreshed 
and  cheerful.  On  the  morning  of  the  eleventh  day- he 
had  an  erection,  which,  however,  was  due  to  a  dis- 
tended bladder,  but  which  nevertheless  was  the  first  of 
the  kind  he  had  experienced  for  several  years. 

On  the  fifteenth  night  he  had  a  lascivious  dream  in 
which  the  usual  images  did  not  appear,  or,  if  they  did — 
and  upon  reflection  he  was  a  little  doubtful  on  the 
point — they  were  much  less  distinct  than  they  had  been. 
They  were  not  accompanied  by  an  emission.  The  next 
morning  he  had  another  erection  accompanied  by  a 
slight  desire,  and  every  morning  thereafter  while  he  re- 
mained under  my  care  he  had  an  erection,  sometimes 
with  and  sometimes  without  sexual  desire. 


I20  SEXUAL   IMPOTENXE   IX   THE    MALE. 

He  had  now  been  two  weeks  under  treatment,  and 
the  general  results  may  be  summed  up  as  follows : 

Sound  sleep  every  night. 

Freedom  from  pain  or  other  uncomfortable  feeling  in 
the  head. 

A  strong,  hearty  appetite,  with  good  gastric  and  in- 
testinal digestion. 

Cessation  of  the  nocturnal  emissions  and  of  the  las- 
civious dreams. 

A  return  of  the  matutinal  erections,  and  of  normal 
desire  in  connection  with  them. 

Frequently  during  the  day  desire  with  erections. 
These,  however,  were  not  as  yet  strong,  and  I  con- 
tinued my  prohibition  in  regard  to  attempts  at  inter- 
course. 

On  the  fifteenth  I  suspended  the  administration  of  the 
bromide  of  sodium,  continuing,  however,  the  mixture 
with  the  other  ingredients  unchanged  ;  and  in  addition 
I  prescribed  the  following  solution: 

B   Strychniae  sulph gr.  i. 

Acidi  hypophos,  dil |  i. 

M.  ft.  sol. 

Dose,  ten  drops  three  times  a  day  before  meals  in  a 
teaspoonful  of  the  fluid  extract  of  coca. 

1  gave  this  mixture  for  the  reason  that  I  know  of  no 
better  tonic  for  the  sexual  orgar.s,  after  the  abnormal 
state  of  erethism  into  which  they  get  by  abuse  has  been 
relieved,  than  strychnia,  hypophosphorous  acid  and 
coca.     It  is  necessary,  however,  not  to  give  it  imme- 


ABSENCE   OF   THE   POWER   OF   ERECTION.  121 

diately  before  going  to  bed,  as  without  this  precaution 
it  may  produce  seminal  emissions. 

From  this  time  on  his  condition  continued  to  improve. 
He  had  gained  over  ten  pounds  in  weight,  was  getting 
stronger  every  day  and  more  cheerful,  and  altogether 
more  normal  in  his  mind.  His  erections  were  occasion- 
ally tolerably  strong,  but,  as  a  rule,  though  he  had 
several  every  day  as  a  consequence  of  the  very  vivid 
desires  which  he  experienced,  they  were  not  yet  by  any 
means  of  natural  strength.  He  was  very  desirous  of 
going  home,  being  convinced  that  he  could  carry  on 
all  the  treatment  but  the  electric  as  well  there  as  in 
New  York.  This  was  probably  true,  but  as  1  attached 
a  great  deal  of  importance  to  this  part  of  the  manage- 
ment of  the  case,  I  declined  to  give  my  consent.  He 
had  now  been  under  my  charge  for  twenty  days,  and  I 
felt  confident  that  a  week  or  two  longer  would  com- 
plete the  cure.  On  the  night  of  the  twenty-first  day 
his  wife  left  her  bed  and  got  into  his,  and  he,  in  disre- 
gard of  his  pledge,  attempted  intercourse,  and  with  a 
measurable  degree  of  success.  I  judged,  however,  that 
the  emission  was  premature.  The  next  morning  he 
was  filled  with  remorse,  and  not  only  renewed  his 
pledge,  but  promised,  in  addition,  that  his  wife  should 
go  home  and  prepare  the  house  for  his  return.  This, 
however,  was  not  what  I  wanted.  I  desired  her  pres- 
ence, under  restraint,  as  a  constant  stimulus  to  him,  but 
I  did  not  want  things  to  be  carried  to  extremes  again 
till  he  was  strong  enough  to  act  his  part  in  a  physio- 


122  SEXUAL   IMPOTENCE   IN   THE   MALE. 

logical  manner.  There  were,  I  have  reason  to  believe, 
no  further  infractions  of  disciphne.  On  the  night  of 
the  thirty-second  day  he  attempted  intercourse  with 
my  partial  consent.  I  knew  he  would  do  better  if  I  al- 
lowed him  to  make  the  attempt  with  seeming  reluc- 
tance than  if  I  gave  him  full  liberty  to  do  as  he  pleased. 
In  sexual  matters,  as  in  many  others,  the  desire  and  the 
power  are  stronger  with  forbidden  fruit  than  wnth  that 
which  can  be  had  for  the  asking.  The  end  fully  justi- 
fied the  means,  for  he  informed  me  the  next  morning, 
with  great  satisfaction,  that  I  was  over  careful  with 
him,  and  that  he  believed  he  had  done  all  that  could 
have  been  reasonably  expected  of  him. 

I  then  allowed  him  to  go  home,  but  continued  all  the 
treatment,  excepting  the  electricity  and  the  nightly 
dose  of  the  mono-bromide  of  camphor.  1  thought  he 
ought  to  continue  the  whole  system,  with  the  excep- 
tions mentioned,  for  three  or  four  months. 

And  I  warned  him  in  the  most  solemn  manner  that, 
under  no  circumstances,  was  he  to  have  sexual  inter- 
course more  frequently  than  once  a  week  for  at  least 
a  year,  and  perhaps  even  longer.  More  than  a  year 
has  now  elapsed,  and  I  have  every  reason  to  believe 
that  he  has  strictly  followed  my  injunction.  He  writes 
that  he  is  determined  not  to  go  beyond  the  limit  fixed, 
that  his  happiness  is  complete,  and  that  neither  he  nor 
his  wife  are  willing  to  exceed  those  moral  and  physio- 
logical bounds  which  nature  has  imposed  ;  that  she  is 
pregnant,  and  that  they  both  look  forward  to  the  birth 


ABSENCE   OF   THE   POWER   OF   ERECTION.  I23 

of  the  child  as  a  sign  that  God  has  forgiven  him  the 
sins  and  indiscretions  of  his  youth. 
•  I  have  dwelt  upon  this  case  and  its  treatment  at  some 
length  for  the  reason  that  it  is  a  type  of  a  large  class, 
showing  the  ordinary  effects  of  early  and  excessive 
masturbation,  and  for  the  additional  reason  that  it' 
shows  what  are,  I  think,  the  therapeutical  principles 
which  should  prevail  in  their  treatment.  It  would  be 
very  easy  to  adduce  similar  examples  from  my  own  ex- 
perience, but  as  showing  that  the  influence  I  speak  of  is 
distinctly  recognized  by  other  writers,  I  cite  the  follow- 
ing from  Deslandes,  which,  although  it  relates  to  a  mem- 
ber of  the  female  sex,  is  equally  applicable  to  males : 

"  Masturbation,"  he  says,  "  instead  of  the  natural 
feeling,  may  induce  in  the  sexual  organs  an  irritability 
quite  different  from  that  caused  by  the  act  of  inter- 
course, and  which  leads  to  results  that  are  far  from 
being  agreeable.  This  fact  was  strongly  impressed 
upon  me  by  the  case  of  a  young  woman  who  was  often 
under  my  professional  care.  At  a  boarding-school  she 
was  taught  masturbation,  and  gave  herself  up  to  it 
without  restraint.  At  seventeen  she  was  married,  and 
had  formed  the  most  voluptuous  ideas  of  the  pleasures 
she  was  about  to  enjoy.  But  what  a  disappointment ! 
Marriage,  instead  of  giving  her  pleasure,  was  the  source 
of  positive  discomfort  and  infinite  pain ;  or  rather,  what 
was  most  frequently  the  case,  she  was  completely  insen- 
sible to  the  caresses  of  her  husband.  Again,  a  state  of 
spasms  and   convulsions  supervened  after  any  attempt 


124  SEXUAL   IMPOTENCE   IN   THE   MALE. 

on  the  part  of  her  husband  at  intercourse,  and  lasted 
for  some  time  afterward." 

It  is  therefore  an  undoubted  fact  that  masturbation 
is  in  itself  more  injurious  to  the  integrity  of  the  virile 
power  than  sexual  intercourse,  not  only  because  it  is 
more  frequently  repeated,  but  because  it  is  generally 
effected  through  the  influence  of  an  exalted  imagination, 
and  not  by  the  reflex  irritation  of  distended  vesiculas 
seminales,  the  only  physiological  incentive  to  copulation. 

But  it  is  not  only,  as  is  generally  supposed,  to  the 
loss  of  semen  that  the  injurious  effects  of  masturbation 
or  of  excessive  indulgence  are  to  be  attributed.  This  is 
undoubtedly  of  some  influence,  but  it  is  not,  I  think, 
the  chief  factor  in  causing  impotence  or  other  disturb- 
ances of  the  healthy  condition  of  the  system.  The  fre- 
quent production  of  the  orgasm  is  of  much  more  con- 
sequence, and  it  is  to  this  cause  that  the  various  de- 
rangements of  the  nervous  system,  as  well  as  weakness 
of  the  virile  power,  or  its  entire  loss,  are  mainly  to  be 
ascribed.  An  idea  is  extremely  prevalent  that  the  loss 
of  a  few  drops  of  seminal  fluid  causes  more  weakness 
of  the  system  than  the  abstraction  of  a  pint  of  blood  : 
nothing  could  be  more  absurd.  The  seminal  fluid  is 
not  secreted  with  any  degree  of  rapidity,  and  if  the 
orgasm  be  produced  several  times  in  the  course  of  a 
brief  period,  it  is  after  the  second  or  third  time,  at  fur- 
thest, unaccompanied  by  any  emission  of  true  semen. 
A  patient  of  my  own  had  intercourse  eleven  times 
during  a  period  of  less  than  eight  hours.     The  first 


ABSENCE   OF   THE   POWER   OF   ERECTION.  125 

three  times  were  accompanied  by  emissions,  but  the 
last  eight  were  entirely  free  from  any  discharge,  though 
the  orgasm  was  complete  in  each.  Shortly  after  the 
eleventh  time  he  had  an  epileptic  fit,  and  became  per- 
manently  impotent,  never  again  experiencing  an  erec- 
tion. 

A  young  man,  during  an  orgie  at  a  house  of  prosti 
tution,  masturbated  nine  times  in  the  course  of  about 
an  hour.  The  first  three  times  there  were  emissions, 
the  fourth  time  only  a  little  thin  fluid  escaped.  The 
other  five  times  the  orgasm  was  experienced,  unaccom- 
panied by  the  slightest  discharge  of  any  kind. 

The  next  morning  he  had  incontinence  of  urine,  and 
subsequently  locomotor  ataxia  was  developed.  The 
penis  was  completely  paralyzed. 

These  cases  are  sufficient  to  show  that  the  evil  effects: 
of  excess  are  not  due  to  seminal  loss,  which  in  neither 
of  the  instances  could  have  exceeded  a  teaspoonful  in 
quantity. 

Moreover,  masturbation  in  boys  before  the  age  of 
puberty,  is  unattended  by  emissions  of  semen,  and  yet 
the  injury  to  the  system  is  greater  at  this  period  than 
at  any  other. 

And  in  women  the  evil  results  of  masturbation  are 
fully  as  great  as  they  are  in  men,  and  with  them  it  is 
the  orgasm  alone  that  can  do  any  damage,  as  there  is 
no  seminal  discharge.     Swediaur*  cites  the  case  of  a 

*  "Trait6  complet  des  maladies  veneriennes."     T.  i.,  p.  160. 


126  SEXUAL   IMPOTENCE   IN   THE   MALE. 

woman  under  his  care  who  suffered  from  frequent 
venereal  orgasms  m  her  sleep,  and  who  in  consequence 
became  affected  with  tabes  dorsalis. 

When  we  call  to  mmd  the  immense  disturbance  of 
the  nervous  system  consequent  upon  the  development 
of  the  sexual  orgasm,  the  mental  vertigo,  the  muscular 
convulsion,  the  cardiac  and  respiratory  excitement,  the 
resemblance  which  all  the  phenomena  have  to  those  of 
an  epileptic  paroxysm  into  which  they  not  infrequently 
pass  by  an  almost  imperceptible  gradation,  we  can  un- 
derstand how  the  too  frequent  repetition  must  lead 
not  only  to  an  extinction  of  the  natural  desire  and 
power,  but  to  a  long  train  of  other  disorders  of  much 
greater  importance  to  the  life  and  health  of  the  indi- 
vidual. The  idea  of  ascribing  all  these  deleterious  re- 
sults to  the  loss  of  a  few  drops  of  seminal  fluid  is 
absurd.  They  would  take  place  equally  certainly,  and 
probably  with  almost  equal  severity,  if  there  were  no 
seminal  fluid  at  all ;  and,  indeed,  in  some  extreme  cases 
of  masturbation  there  is  no  seminal  secretion  in  the 
true  sense  of  the  term,  and  yet  the  process  of  mental 
and  physical  decay  goes  on  with  even  more  sureness 
than  in  the  early  days  of  the  victim's  practice  of  the 
vice. 

There  are  several  conditions  which  may  be  induced 
by  the  immediate  action  of  the  orgasm  which  are  in 
fact  continuations  of  it,  and  which  can  in  no  sense  be 
ascribed  to  the  loss  of  semen.  For  the  semen  is  as 
much  out  of  the  system  when  in  the  vesiculae  seminales 


ABSENCE   OF   THE   POWER   OF   ERECTION.  12/ 

as  the  urine  is  out  of  the  blood  when  in  the  bladder. 
The  mere  discharge  of  this  from  one  receptacle  to  an- 
other cannot  produce  any  effect  upon  the  organism, 
the  deleterious  results  being  caused  by  the  demand  for 
the  secretion  of  repeated  quantities  of  semen,  and  not 
by  the  emission  of  a  collection  already  secreted.  When, 
therefore,  we  see,  in  addition  to  epilepsy,  cerebral 
hemorrhage,  chorea,  insanity,  neuralgia,  and  certain 
forms  of  spinal  paralysis  following  the  orgasm  imme- 
diately, and,  indeed,  sometimes  supervening  synchro- 
nously with  it,  we  cannot  doubt  its  influence  over  the 
mind  and  body,  or  fail  to  perceive  that  its  too  frequent 
repetition  must  indubitably  lead  to  grave  disturbances 
of  one  or  the  other,  or  both. 

Probably  the  act  of  masturbation  or  of  sexual  inter- 
course is  somewhat  more  injurious  to  males  than  to 
females.  More  cases  of  disturbances  caused  thereby  in 
boys  and  men  than  in  girls  and  women  come  under  the 
observation  of  physicians,  but  this  is  to  a  great  extent 
due  to  the  fact  that  females  do  not  indulge  in  the  vice 
of  masturbation  to  anything  like  the  extent  to  which  it 
is  practised  by  males — that  is,  so  far  as  number  is  con- 
cerned. In  individual  cases,  when  it  is  once  begun,  I 
am  inclined  to  think  that  girls  and  women  carry  it  to  a 
fully  as  great,  if  not  a  greater,  extreme  than  do  boys 
and  men.  The  demoralization  is  greater,  the  sense  of 
shame  is  more  thoroughly  abolished ;  but  the  other 
effects  are  certainly  less  than  in  the  male  sex.  Still, 
disorders  of  body  and  mind  do  occur  in  them  as  the 


128       SEXUAL  IMPOTENCE  IN  THE  MALE. 

results  of  continued  excess,  and  not  infrequently  as  the 
direct  and  immediate  results  of  repeated  orgasms  with- 
in a  short  period.  I  have  had  two  cases  of  paralysis  of 
motion  in  both  lower  extremities  occurring  in  women  as 
the  results  of  excessive  coition  during  a  single  night,  and 
very  many  of  spinal  irritation  and  other  affections  of  the 
nervous  system,  the  immediate  effects  of  a  like  cause. 

Sexual  excesses  in  adult  life,  though  often  leading  to 
impotence  more  or  less  permanent  in  character,  are  not 
so  certain  to  result  in  that  condition  as  those  which  are 
practised  before  the  age  of  pubert}',  or  before  the  body 
has  attained  to  maturity.  Still,  cases  of  the  kind  are 
common  enough,  and  undoubtedly  the  fact  that  almost 
every  man  who  indulges  in  sexual  intercourse  does  so 
to  excess,  is  the  cause  of  the  supervention  of  impotence 
at  an  age  when  the  individual  ought  to  be  in  the  full 
possession  of  all  his  powers.  It  is  no  uncommon  thing 
to  meet  with  men  of  fifty,  forty,  or  even  thirty,  years  of 
age,  whose  desires  are  as  strong  as  they  ever  were,  who 
are  absolutely  incapable  of  intercourse,  or  else  possess 
the  faculty  in  a  very  faint  degree,  and  in  whom  the 
existing  condition  is  clearly  the  result  of  excess. 

It  often  happens  that  excess  is  committed  without  the 
individual  being  at  all  aware  that  he  is  exceeding  the 
normal  limits.  The  question  then  arises,  what  is  ex- 
cess? There  are  men  who  think  it  entirely  within 
bounds  to  have  intercourse  once  ever}'  twenty-faur 
hours ;  others,  again,  indulge  regularly  twice  a  week ; 
others  once ;  still,  others  who  think  once  a  month  suffi- 


ABSENCE   OF  THE   POWER   OF   ERECTION.  I2<j 

cient.  It  is  exceedingly  difficult  to  lay  down  any  rule 
in  the  matter  which  will  be  applicable  for  all  men  ;  in- 
deed, the  task  would  be  insuperable,  for  all  men  are  not 
alike,  and  what  would  be  excess  foi"  one  would  be  mod- 
eration for  another.  But  it  may  be  said  unhesitatingly 
that  intercourse  to  the  extent  of  once  every  twenty-four 
hours  is  excess  for  the  strongest  men  who  ever  lived. 
There  are  many  who  can  practise  it  without  marked 
'deterioration  of  their  powers  for  several  years,  but  the 
time  inevitably  comes,  in  advance  of  the  normal  period 
of  diminution  of  power,  when  impotence  begins  to  make 
its  appearance.  Twice  a  week  is  certainly  excess  for 
the  majority  of  men,  and  will  certainly  lead  to  earlier 
than  normal  extinction  of  the  sexual  powders.  Once  a 
week  is  more  generally  applicable,  and  can  as  a  rule  in 
healthy  men  be  taken  as  a  guide  from  the  twenty-fifth 
to  the  fortieth  year.  Previous  to  the  twenty-first  year 
sexual  intercourse  should  not  be  practised  at  all ;  and 
between  that  age  and  twenty-five,  if  indulged  •  in,  it 
should  certainly  not  be  more  frequently  than  once  in 
ten  or  twelve  days ;  and  it  is  a  law  to  which  there  are 
no  exceptions  that  the  greater  the  excess  the  sooner  will 
the  natural  power  be  lost.  If  the  individual  desires  to 
retain  his  ability  to  a  green  old  age,  he  will  not  tax  it 
too  severel}^  in  his  youth. 

That  the  civilized  man  is  in  general  excessive  in  the 
matter  of  sexual  intercourse  admits  of  no  question,  ^and 
we  see  the  effects  constantly  in  the  early  loss  of  tne 
power.     The  reading  of  obscene  books,  the  witnessing 


130  SEXUAL   IMPOTENCE   IN   THE    MALE. 

of  sexually  suggestive  plays,  the  very  impediments 
which  society  necessarily  places  in  the  way  of  the  un- 
restrained indulgence  of  the  passions,  act  with  some 
men  as  direct  excitations  to  sexual  indulgence.  In  civi- 
lized communities  it  will  alwa)'S  happen  that  such  causes 
act  with  m  ich  greater  force  than  among  savages,  where, 
in  fact,  they  are  scarcely  exhibited  at  all,  and  where  the 
promptings  of  nature  are  alone  the  incentives  to  the  act 
of  copulation.  The  consequence  is,  that,  other  things 
being  equal,  the  civilized  man  becomes  impotent  at  a 
much  earlier  age  than  his  uncivilized  brother. 

How  many  men  of  sixty  years  of  age  in  the  city 
of  New  York  are  capable  of  natural  and  satisfactory 
intercourse?  Not  one  in  twenty,  and  3'et  the  power 
ought  to  be  retained,  and  is.  in  the  cases  of  those  who 
have  been  temperate  in  its  use  up  to,  and  even  beyond, 
the  age  of  three  score  and  ten.  Indeed,  it  is  rare  to 
find  a  man  of  fifty  who  has  so  husbanded  his  powers  as 
to  admit  of  his  having  sexual  intercourse  once  a  fort- 
night, and  then  the  act  is  neither  satisfactory  to  him  nor 
the  recipient.  But  at  times  a  more  serious  evil  than 
the  comparatively  early  decay  of  the  sexual  power  is  ob- 
served as  the  consequence  of  excess,  and  this  is  the  su- 
pervention of  impotence  either  suddenlv,  after  some 
extraordinary  indulgence,  or  more  gradually,  in  conse- 
quence of  repeated  excesses.  In  these  cases  the  desire 
remains  in  as  active  a  condition  as  it  ever  existed  ;  at- 
tempts at  intercourse  are  made,  these  fail ;  renewed 
efforts  are  made,  with  extraordinary  excitants  to  erec- 


JVBSENCE   OF  THE   POWER   OF   ERECTION.  I31 

tion ;  but  all  in  vain,  the  penis  remaining  limp  and  flac- 
cid to  every  normal  and  abnormal  stimulus,  and  the 
condition  becoming  more  profound  with  each  failure. 

The  effect  is  by  no  means  restricted  to  the  generative 
organs.  The  patient  becomes  morbid,  both  from  chag- 
rin which  follows  his  futile  attempts  at  intercourse,  and 
the  apprehension,  which  is  generally  entertained,  that 
some  serious  mental  disease — insanity  or  imbecility,  for 
instance — will  result  from  the  "  softening  of  the  brain  " 
which  he  thinks  has  taken  place,  or  is  about  to  be  pro- 
duced. Besides  this,  he  is  the  subject  of  regrets  and 
remorse  for  his  past  offences  against  the  laws  of  his 
being,  and  is  just  in  that  frame  of  mind  which  makes 
him  an  easy  prey  to  the  wiles  of  quacks  and  other  medi 
cal  impostors.  He  therefore  runs  from  one  to  the  other 
of  these  knaves  and  frauds :  mesmerizers,  clairvoyants, 
"  natural  healers,"  anatomical  museums,  layers  on  of 
hands,  faith-curers,  etc.,  etc.,  in  the  vain  search  for 
something  that  will  enable  him  to  recover  the  power 
he  has  lost,  with  no  other  result  than  to  deplete  his 
pocket,  in  the  meantime  making  constant  attempts  at 
sexual  intercourse  by  experimenting  with  one  woman 
after  another,  and  always  with  the  same  issue — failure. 

A  careful  examination  of  these  cases,  and  full  inquiry 
into  the  circumstances  attending  the  condition,  reveal 
the  facts  that  there  has  been  no  erection  at  all,  or  else 
so  feeble  a  one  as  to  render  the  intromission  of  the 
penis  into  the  vagina  an  impossibility.  Sometimes  an 
emission  of  semen  has  taken  place,  but  this  has  been  ex- 


132  SEXUAL   IMPOTENCE   IN   THE   MALE. 

ternal  to  the  vulva,  and  has  only  served  to  render  the 
state  still  more  deplorable,  for  it  has  occurred  without 
an  erection,  and  only  as  a  consequence  of  the  extreme 
debility  of  the  whole  generative  apparatus. 

And  this  brings  us  to  the  consideration  of  t\\2it  partial 
impotence  which  is  one  of  the  most  frequent  results  of 
sexual  excesses,  and  in  which  the  erection  is  so  feeble 
and  the  erethism  so  great  that  emission  and  an  imper- 
fect orgasm  ensue  either  before  an  entrance  has  been 
effected,  or  so  soon  thereafter  that  the  act  of  intercourse 
is  unsatisfactory  to  both  parties.  This  condition  is 
often  preliminary  to  the  more  complete  loss  of  power, 
and  again  it  may  continue  for  an  indefinite  period,  or 
may  disappear  under  treatment. 

In  other  cases  there  is  an  erection,  and  the  individual 
thinks,  till  he  learns  better  by  experience,  that  there  is 
going  to  be  no  difficulty  in  accomplishing  the  act  of 
sexual  intercourse;  but  just  as  the  attempt  is  made  to 
effect  entrance,  although  there  may  be  no  loss  of  desire 
and  no  mental  difficulty  in  the  way,  the  penis  becomes 
flaccid,  and  again  disappointment  is  the  result,  there 
being  no  emission  and  no  orgasm. 

These  states  of  partial  impotence  are  very  common, 
especially  in  those  persons  who  have  arrived  at  middle 
age,  but  in  whom  normally  there  ought  to  be  almost  as 
great  a  degree  of  power  as  there  ever  was.  For  it  is  to 
be  noted  that  when  in  the  course  of  advancing  years 
the  period  is  approaching  in  which,  according  to  physio- 
logical laws,  the  individual  may  expect  to  undergo  the 


ABSliNCE   OF  THE   POWER   OF   ERECTION.  1 33 

natural  loss  of  sexual  power,  which  is  the  common  lot 
of  all  men,  the  failure  is  shown,  not  by  any  imperfec- 
tion in  the  act,  but  by  the  healthy  demand  for  its  repe- 
tition coming  less  frequently.  Besides,  in  this  physio- 
logical impotence  the  desire  disa.ppea.TS  pari  passu  with 
the  power,  and  the  individual  accordingly  yields  grace- 
fully to  the  merciless  law  of  his  being.  In  that  impo- 
tence, however,  which  is  brought  about  by  the  impru- 
dence of  the  individual  in  committing  the  act  of  inter- 
course more  frequently  than  he  ought,  or  with  extrane- 
ous accessories,  which  heat  the  imagination  for  the 
time  being  and  leave  it  a  blank  thereafter,  the  desire 
often  remains  unimpaired,  while  the  power  is  dimin- 
ished or  altogether  lost,  and  there  are  consequently 
regrets,  chagrins,  disappointments,  and  a  constant  state 
of  warfare  between  the  flesh  and  the  spirit.  It  may  be 
laid  down  as  a  law,  to  which  there  are  few,  if  any,  ex- 
ceptions, that  whenever  there  is  desire,  without  full 
power,  the  resulting  impotence  is  a  veritable  disease, 
and  not  a  physiological  condition  coming  in  the  regular 
course  of  life. 

In  regard  to  the  character  of  the  excess  that  may  re- 
sult in  complete  or  partial  impotence,  it  is  generally, 
though  by  no  means  always,  in  adults,  sexual  inter- 
course rather  than  masturbation.  The  latter  is  more 
especially,  as  we  have  seen,  a  habit  of  childhood  and 
youth,  though  there  are  many  men  who  practice  it  to 
the  exclusion  of  sexual  intercourse,  or  in  connection 
therewith.     In  all  these  cases  the  same  remarks  may 


134  SEXUAL   IMPOTENCE   IN   THE    MAr.E. 

be  made  in  regard  to  it  as  were  made  in  the  previous 
chapter,  with  the  additional  observation,  that  it  is 
equally  as  destructive  to  sexual  power  as  it  is  to  sexual 
desire,  not,  however,  from  any  circumstance  inherent 
in  the  act  itself,  but  because  it  is  certain  to  be  more 
frequently  repeated  than  it  is  possible  generally  to  re- 
peat the  act  of  intercourse. 

In  addition,  some  men  who  find  themselves  impotent 
in  all  attempts  to  perform  the  sexual  act,  not  from  lack 
of  desire,  but  from  failure  of  power,  are  very  apt  to 
enter  upon  a  systematic  course  of  masturbation,  a  pro- 
ceeding in  which,  to  a  still  ffreater  degradation  of  the 
sexual  instinct  and  abolition  of  power,  an  emission  and 
an  orgasm  can  be  procured  without  erection. 

The  same  plan  may  be  adopted  by  elderly  men  in 
whom  natural  desire  and  power  have  faded,  but  who 
reawaken  both  in  an  imperfect  degree  by  lascivious  prac- 
tices of  various  kinds  or  even  by  indulgence  in  libidi- 
nous thoughts.  These  cases  are  among  the  most  la- 
mentable that  come  under  notice,  especially  when  the 
act  is  practiced  so  frequently  and  under  such  very  dis- 
gusting accompaniments  or  excitants  as  tend  to  the  pro- 
duction of  various  affections — such  as  epilepsy  or  cere- 
bral hemorrhage,  for  instance,  of  the  nervous  system. 
I  have  had  under  observation,  the  case  of  an  old  man 
of  seventy-three,  who  every  afternoon  had  two  young 
girls  visit  him,  and  practice  buccal  masturbation  upon 
him  one  after  the  other,  with  scarcely  a  quarter  of  an 
hour's  interval.     Upon  one  occasion,  on  which  the  pro- 


ABSLNCE    OF   THE   POWER   OF   ERECTION.  135 

cedure  was  being  effected,  he  suddenly  became  para- 
lyzed on  one  side,  and  deprived  of  the  power  of  speech 
as  the  result  of  the  rupture  of  a  blood  vessel  in  his  brain. 

In  another  case,  the  patient,  a  man  of  over  seventy, 
was  affected  with  paralytic  tremor  due  probably  to  dis- 
seminated sclerosis  of  the  brain,  which  was  clearly  the 
result  of  excessive  masturbation  of  which  he  had  been 
guilt}^  for  several  years.  In  this  instance  the  appetite 
was  unnaturally  excited  by  lascivious  books  and  pict- 
ures, and  although  he  never  obtained  an  erection,  he 
succeeded  by  this  system  of  over-stimulation  in  caus- 
ing such  a  state  of  erethism  that  an  imperfect  emission 
and  orgasm  were  produced.  One  day,  while  engaged 
in  the  act,  he  experienced  a  slight  sensation  of  vertigo, 
and  at  once  tremor  began  in  the  right  hand.  This  be- 
came more  severe,  and  gradually  extended  to  the  other 
hand,  and  the  head  and  neck.  Eventually  both  legs 
were  similarly  affected,  and  now  he  walks  with  a  festi- 
nating  gait  and  is  evidently  passing  into  a  state  of  senile 
dementia. 

In  my  experience,  in  every  case  in  which  masturba- 
tion is  practiced  to  any  considerable  extent — and  ex- 
cess in  these  cases  is  the  rule — by  persons  in  whom 
the  natural  desire  and  power  are  in  a  state  of  physio- 
logical decline,  morc^  or  less  injury  of  the  nervous  syS' 
tern  is  entailed,  and  vhe  life  of  the  individual  is  mate- 
rially shortened. 

Sometimes,  however,  it  is  the  case  that  the  tendency 
to  such  acts  is  the  consequence  and  not  the  cause  of  the 


1 30  SKXL'AL    IMPOTKN'CE    IN    THE    MALE. 

existing  mental  derangement.  In  several  forms  of  in- 
sanity the  proclivity  in  question  is  exhibited  in  an  ex- 
treme degree  and  constitutes  one  of  the  most  distressing 
manifestations.  Many  of  the  cases  of  sexual  depravity 
witnessed  in  old  men  are  prodromata  of  senile  dementia, 
and  in  younger  persons  of  general  paralysis.* 

Another  cause  of  impotence  in  adult  life,  the  opera- 
tion of  which  may  begin  in  youth  and  continue  till  the 
individual  is  well  advanced  in  years,  or  engages  in  sex- 
ual intercourse,  is  the  nocturnal  emission  of  setnen.  The 
influence  of  this  factor  is,  however,  in  general  very  much 
overestimated,  it  being  rarely  the  case  that  it  of  itself  is 
productive  of  any  serious  disturbance  of  the  health  of 
the  reproductive  organs.  On  the  contrary,  it  is  in  the 
great  majority  of  cases  a  perfectly  normal  phenomenon, 
and  one  more  calculated  to  do  good  than  harm  to  the 
system,  but  when  too  frequent  or  when  existing  in  con- 
junction with  sexual  excesses,  nocturnal  emissions  are 
capable  of  causing  marked  deterioration  of  the  sexual 
power  or  adding  to  that  which  is  already  present. 

A  few  words  in  relation  to  the  physiology  of  the  sub- 
ject will  not  be  out  of  place,  inasmuch  as  they  may  serve 
to  place  the  matter  in  its  true  light,  and  relieve  the 
anxiety  which  many  physicians  not  infrequently  feel  in 
regard  to  patients  in  whom  the  condition  exists,  and 
which  all  their  medical  treatment  does  not  suffice  to 
abolish. 

^A  Treatise  on  Insanity  in  its  Medical  Relations.  By  William  A 
Hammond,  M.D.     New  York,  18S3. 


ABSENCE    Gt    THE    POWER   OF    ERECTION.  1 37 

In  young  men  of  entirely  chaste  habits  it  generally 
happens  that  soon  after  the  supervention  of  puberty 
nocturnal  emissions  begin  to  occur.  So  long  as  they 
are  not  more  frequent  than  once  in  a  fortnight,  they  are 
strictly  within  the  limits  of  health,  at  least  the  health  of 
civilized  man.  They  show  that  in  the  course  of  the  de- 
velopment of  the  reproductive  system  semen  is  being 
secreted,  and  that  when* the  vesiculas  seminales  become 
full,  nature  steps  in,  and  in  her  own  way  empties  them. 
If  the  young  man  keeps  his  thoughts  pure,  avoids  late 
suppers  and  exciting  amusements,  which  create  em- 
otional disturbance,  and  does  not  sleep  on  his  back,  noc- 
turnal emissions  would  be  unusual  in  their  occurrence, 
and  would,  probably,  in  a  young  man  past  the  age  of  six- 
teen, not  occur  as  often  as  once  in  six  months.  But  in 
practice  it  happens  almost  invariably  that  the  thoughts 
are  not  kept  pure,  amorous  romances  and  plays,  the  in- 
termingling of  the  sexes,  the  sight  of  suggestive  statues 
and  pictures,  association  with  other  boys  who  indulge 
in  lascivious  conversations,  the  sight  of  animals  copulat- 
ing, and  many  other  factors,  are  all  so  many  excitants 
of  the  genesic  function  which  cannot  be  avoided,  and 
which  in  many  cases  it  is  not  proper  to  avoid,  unless 
we  would  have  our  boys  grow  up  without  any  emo- 
tional development.  The  chaste  and  well  instructed 
boy  does  not  masturbate.  The  idea  of  such  an  act  is 
disgusting  to  him,  but  he  goes  to  bed,  and  in  his  sleep 
has  a  dream  in  which  the  impressions  made  through 
the  day  are  revived,  and  the  cerebrum  not  then  having 


138       SEXUAL  IMPOTENCE  IN  THE  MALE. 

the  full  control  of  the  lower  nerve  centers,  these  act  in 
accordance  with  the  idea  presented  by  the  brain,  and  the 
sexual  orgasm  occurs.  Such  an  event  happening  once 
in  two  or  three  weeks  does  no  harm.  But  if  by  the 
reading  of  obscene  books,  looking  at  lascivious  pictures, 
or  what  is  perhaps  still  worse,  immodest  conduct  or 
conversation  with  individuals  of  the  other  sex,  the 
frequency  of  the  emissions  is  materially  increased,  then 
the  case  is  different,  for  not  only  may  there  then  be 
general  and  nervous  debility,  and  other  evidences  of 
bad  health,  but  impotence  more  or  less  complete  may 
be  the  result.  If,  in  addition,  masturbation  be  per- 
formed with  all  its  accompaniments  of  lascivious  ima- 
ges, nocturnal  emissions  are  quite  certain  to  ensue  and 
to  pass  beyond  a  healthy  standard  as  to  frequency. 

Sleeping  on  the  back,  by  allowing  the  blood  to  settle 
in  the  spinal  cord  and  medulla  oblongata,  so  as  to  pro- 
duce a  state  of  passive  congestion,  and  also  by  allowing 
these  parts  to  become  over-heated  increases  the  reflex 
excitability  of  the  generative  organs,  and  hence  predis- 
poses to  the  occurrence  of  nocturnal  emissions. 

As  stated,  emissions  during  sleep  are  usually  pre- 
ceded or  accompanied  by  lascivious  dreams,  but  this  is 
not  always  the  case,  as  they  sometimes  occur  without 
any  such  excitation.  This,  however,  only  happens  in 
cases  of  advanced  sexual  debility,  or  in  those  instances 
in  which  the  desire  of  the  individual  is  extinguished. 

In  regard  to  diurnal  emissions,  physicians  hear  much 
from  patients  of  their  passing  their  semen  when  strain- 


ABSENCE   GF   THE   POWER    OP    ERECTION.  1 39 

ing  at  stool  and  of  its  escaping  with  the  urine.  Though 
perhaps  such  cases  are  possible,  they  are  certainly  ex- 
ceedingly rare.  In  my  opinion  not  one  case  in  a  hun- 
dred of  alleged  escape  of  semen  during  defecation  or 
urination  is  in  reality  an  instan^je  of  such  an  event. 
In  states  of  great  constipation,  in  which  the  fecal  mass 
is  large  and  hard,  a  little  prostatic  fluid  or  urethral 
mucus  may  be  squeezed  out  during  severe  straining, 
but  the  emptying  of  the  vesiculse  seminales  by  such  a 
cause  is  the  rarest  of  occurrences,  and  when  it  does 
happen  it  is  no  great  matter.  In  the  whole  course  of 
my  experience  I  have  seen  but  one  case  in  which  there 
was  an  escape  of  semen  during  defecation,  and  in  that 
'  there  was  some  approach  to  an  orgasm.  The  patient, 
a  middle-aged  man,  had  practised  masturbation  since 
childhood,  had  in  adult  years  been  excessively  addicted 
to  women,  and  had,  moreover,  further  reduced  his 
strength  by  an  inordinate  indulgence  in  the  use  of 
alcoholic  liquors.  In  this  instance,  when  defecation 
took  place,  great  muscular  efforts  were  requisite  in 
order  to  effect  the  process,  and  almost  invariably  an 
imperfect  orgasm  with  an  emission  of  semen  took 
place. 

In  regard  to  the  passage  of  semen  with  the  urine,  an 
event  which  is  supposed  by  some  to  occur  in  conse- 
quence of  the  secretion  flowing  back  into  the  bladder 
and  then  being  discharged  during  micturition,  I  am 
quite  sure  that  this  never  happens  in  the  way  men- 
tioned.    It  is  not  uncommon  to  find  spermatozoa  in  the 


I40  SEXUAL   IMPOTENCE   IN   THE   MALE. 

urine  first  discharged  after  sexual  intercourse,  for  the 
emission  accompanying  the  orgasm  always  results  in  a 
little  of  the  semen  remaining  in  the  urethra,  to  be 
washed  out  with  the  next  passage  of  urine.  But  the 
notion  of  the  semen,  gradually  and  without  orgasm, 
flowing  back  into  the  bladder  and  then  being  evacuated 
is  the  veriest  nonsense  in  the  world. 

Among  points  interesting  in  this  connection,  Sif 
James  Paget  *  discusses  the  one  now  under  notice,  in 
the  following  words. 

"  As  to  semen  passing  with  the  urine,  1  am  nearly 
certain  that  it  never  does  so  unless  when  an  emission 
has  lately  taken  place,  or  where  there  has  been  disease 
of  a  seminal  vesicle.  In  the  former  case,  some  semen 
remaining  in  the  walls  of  the  urethra,  or  possibly 
having  passed  into  the  bladder,  is  washed  out  with  the 
next  stream  of  urine,  and  may  be  found  in  it  with  the 
microscope.  I  once  examined,  for  many  days  in  suc- 
cession, the  urine  of  a  patient  who  was  persuaded  that 
he  passed  semen  with  it,  and  semen  could  always  be 
found  when  he  had  had  a  nocturnal  emission,  but  never 
on  any  other  occasion.  A  former  colleague  of  mine 
assured  me  that  he  had  often  observed  the  same  thing 
after  copulation,  and  this  I  believe  is  the  whole  truth 
concerning  semen  passing  with  the  urine;  whatever 
may  chance  to  be  left  in  the  urethra  after  an  emission 
is  washed  out.     But  that  which  frightens  the  ignorant 

*  "Clinical  Lectures  and  Essays"  (Sexual  Hypochondriasis).  New 
York,  1S75.  p.  271. 


ABSENCE   OF   THE   POWER   OF   ERECTION.  I41 

and  the  hypochondriacal  is  not  even  this:  it  is  mucus 
of  the  urinary  passages  either  quite  healthy  or  in  some 
trivial  manner  changed.  This  form  of  what  is  called 
spermatorrhoea,  therefore,  should  be  treated  by  in- 
struction, which  the  merely  ignorant  will  receive,  and 
the  hypochondriacal  very  likely  will  not. 

"  Not  much  unlike  this  misunderstanding  about  vesi- 
cal mucus  is  another  in  which  some  people,  chiefly 
middle-aged  and  elderly,  with  diminishing  sexual 
powers,  make  themselves  miserable.  They  find  in 
their  urine  little  flakes  or  threads  of  floating  mucus, 
which  they  say  are  always  washed  out  of  the  urethra 
at  the  beginning  of  the  urine-stream,  especially  in  the 
morning.  They  watch  these  with  the  greatest  anxiety, 
and  send  them  to  you  on  bits  of  paper  or  of  glass, 
begging  you  to  examine  them  very  carefully.  I  be- 
lieve that  they  are  bits  of  prostatic  mucus  secreted  in 
the  night  and  washed  out  with  the  morning  urine.  But 
whatever  they  may  be  they  are  not  of  the  least  im- 
portance. You  may  find  them  passed  by  men  who 
neither  know  nor  care  anything  about  them  and  whom 
they  never  harm,  and  even  hypochondriacs  go  on 
month  after  month  passing  them  and  yet  suffering 
nothing  but  their  mental  misery." 

Cases  in  which  this  delusion  is  entertained  are  com- 
mon enough  in  the  practice  of  every  physician,  and  the 
subjects  of  it  are  encouraged  to  believe  in  its  truth  by 
the  various  quacks  who  pretend  to  cure  them,  while  at 
the  same  time  exaggerating  the  importance  of  every 


142  SEXUAL   IMPOTENCE   IN   THE    MALE. 

little  out-of-the-way  circumstance  that  may  exist.  They 
know  well  that  their  chief  way  to  illicit  gains  is  by 
frightening  the  patient  in  making  him  believe  that  he 
is  on  the  high  road  to  impotence,  and  softening  of  the 
brain,  and  that  they  alone  recognize  the  danger  he  is  in. 
In  this  way  the  patient  is  brought  to  a  condition  of 
what  may  be  called  "false  impotence."  He  is  afraid  to 
make  the  attempt  at  sexual  intercourse  lest  in  failing 
he  should  have  his  worst  fears  realized. 

Again,  the  patient  supposes  that  he  is  subject  to 
emissions  of  semen  without  the  orgasm,  and  solely  as 
the  result  of  venereal  excitement.  It  is  true  that  in 
most  persons,  there  is,  under  the  condition  in  question. 
a  slight  glairy  exudation  from  the  meatus,  but  this  is 
simply  mucus  secreted  by  the  lining  membrane,  and  its 
excretion  is  nothing  more  than  a  physiological  pheno- 
menon without  the  least  pathological  importance.  In 
regard  to  this  subject  Sir  James  Paget  says :  * 

"Another  subject  of  gloom  and  alarm  to  some  is,  that 
during  sexual  excitement,  and,  as  they  suppose,  worse 
still,  when  they  wake  in  the  morning,  they  find  a  clear 
colorless  fluid  flowing  from  the  urethra,  or  easily 
pressed  from  it.  Here,  again,  the  complaint  is  of  that 
which  is  natural,  and  it  will  be  quite  as  just  if  directed 
against  tears  during  grief.  The  urethra  naturally 
secretes  mucus  during  sexual  excitement;  it  secretes 
more  or  less  in  different  persons,  but  some,  I  believe, 
in  all:  and  as  for  the  morning  secretion,  it  is  due  either 

*  Op.  cit. ,  p.  273. 


ABSENCE   OF   THE    POWER   OF   ERECTION.  I43 

to  some  sexual  excitement  during-  sleep,  forgotten  be- 
fore waking,  or  to  the  general  condition  of  turgescence 
or  erection  of  the  sexual  organs  which  in  most  healthy 
persons  exists  during  sleep  or  some  part  of  it.  In  no 
case  is  this  clear  urethral  mucus  a  sign  or  conse- 
quence of  disease,  unless,  indeed,  where  an  excess  of 
it  is  a  residue  of  gonorrhoea.  It  is,  I  think,  most  abun- 
dant and  most  quickly  formed  in  those  whose  sexual 
organs  are  more  irritable  than  potent,  but  this  is  the 
worst  that  can  be  said  of  it ;  and  even  in  these  it  is  not 
the  sexual  organs,  but  some  part  of  the  nervous  sys- 
tem, the  brain  or  the  spinal  marrow,  that  is  in  the 
wrong.  In  no  case  does  the  secretion  deserve  to  be 
called  or  treated  as  a  disease." 

These  cases  are  almost  as  bad  as  those  in  which  the 
subjects  think  they  are  becoming  impotent  because 
they  have  discovered  that  one  testicle  hangs  lower  than 
the  other. 

But  there  are  involuntary  diurnal  emissions  in  which 
the  semen  is  discharged  with  an  orgasm  in  consequence 
of  friction  of  the  penis  against  the  clothing,  or  as  the 
result  of  lascivious  thoughts  or  acts.  But  these  con- 
ditions show  loss  of  power  with  increase  of  irritability, 
and  are  usually  the  results  of  great  excesses.  The 
individual  in  whom  they  occur  is  generally  impotent  to 
the  physiological  stimulus  to  sexual  intercourse. 

In  the  first-named  class  of  cases  the  patient  may  have 
emissions  while  walking,  or  especially  while  riding 
horseback.     The  emission  is  accompanied  with  an  im- 


144  SEXUAL   IMPOTENCE    IN   THE    MALE. 

perfect  orgasm,  and  the  erection  is  usually  very  feeble. 
Indeed,  in  most  cases  there  is  nothing  that  can  with 
propriety  be  called  an  erection,  only  a  slight  turges- 
cence  of  the  penis  being  produced. 

In  the  second  the  like  series  of  events  takes  place  in 
consequence  of  some  impression  of  a  voluptuous  char- 
acter  being  made  upon  the  mind,  not  as  in  the  cases 
described  in  the  previous  chapter,  by  his  concurrence 
and  action,  but  against  kis  inclination.  Indeed,  in 
some  instances  the  slightest  reference  to  sexual  matters 
in  the  presence  of  an  individual  of  the  class  referred  to, 
is  sufficient  to  cause  an  emission.  In  one  case  that 
came  under  m}'^  observation,  the  patient,  a  man  about 
forty  years  of  age,  who  had  exhausted  his  powers  by 
great  excesses,  and  had  also  brought  the  generative 
system  to  a  state  of  great  erethism,  the  sight  of  a 
woman  getting  into  an  omnibus  and  thus  showing  an 
inch  or  two  of  her  ankles,  or  of  another  with  bare  neck 
and  arms,  was  sufficient  to  cause  an  emission  without 
erection  and  with  scarcely  the  semblance  of  an  orgasm. 

Both  these  causes  ma}''  lead  to  impotence,  though 
often  they  are  accompaniments  of  this  state,  and  like  it, 
are  evidences  of  the  weak  condition  of  the  generative 
system. 

There  are  other  factors  besides  excess  which  are 
capable  of  producing  such  a  loss  of  virile  power  as  to 
lessen  or  altogether  abolish  the  capacity  for  erection, 
and  consequently  to  render  the  individual  impotent. 
Among  these  are  various  conditions  and  diseases  both 


ABSENCE   OP^   THE   POWER   OF   ERECTION.  I45 

of  a  general  and  local  character,  of  the  generative  sys- 
tem specially,  or  of  other  parts  of  the  body. 

Obesity,  due,  as  it  often  is,  to  defects  in  the  processes 
of  assimilation  and  elimination,  may  be  accompanied 
by  a  feeble  condition  of  the  generative  system.  I  have 
seen  this  fact  markedly  shown  in  the  cases  of  two 
gentlemen,  each  of  whom,  though  not  exceeding  five 
feet  eight  inches  in  height,  weighed  three  hundred,  and 
two  hundred  and  eighty  pounds  respectively.  There 
had  never  been  excess  in  either  case,  both  were  mar- 
ried, and  both,  with  the  inception  of  the  obese  state, 
began  to  fail  in  the  power  of  erection,  till  eventually 
sexual  intercourse  was,  from  this  condition,  rendered 
impossible.  It  will  be  understood  here,  that  the  diffi- 
culty was  not  a  mechanical  one  of  a  protuberant  abdo- 
men— that  question  will  be  considered  in  the  ensuing 
chapter — but  one  which  related  entirely  to  the  power 
of  erection. 

Eventually  both  these  gentlemen  were  cured,  and  the 
result  established  the  correctness  of  the  opinion  given, 
that  the  impotence  was  the  result  of  a  constitutional 
cause.  By  enjoining  a  diet  from  which  sugar,  starch 
and  fat  were  rigidly  excluded,  the  weight  was  reduced 
sixty  pounds  in  one  case  and  forty  seven  in  the  other, 
not  only  Avith  the  effect  of  restoring  the  virile  power, 
but  with  greatly  improved  health  in  other  respects. 

Emaciation,  when  extreme,  is,  even  more  than  obesity, 
due  to  derangement  of  the  nutritive  system,  and  like  it, 
may  be  productive  of   impotence.      This  condition  is 


146  SEXUAL   IMPOTENCE   IN   THE    MALE. 

Still  more  liable  to  result  when,  in  addition  to  general 
emaciation,  the  testicles  and  penis  become  the  subjects 
of  atrophy.  Then  the  loss  of  virile  power  becomes  a 
permanent  condition,  to  remain  during  the  life  of  the 
individual.  Fortunately  for  the  patient,  there  is,  in 
these  cases,  a  loss  of  desire  as  well  as  of  power,  so  that 
in  oreneral  the  state  is  not  one  in  which  there  are  end- 
less  chagrins  and  disappointments.  Exception,  how- 
ever, must  be  made  in  the  cases  of  some  married  men 
who  are  unable  from  the  first  to  consummate  the  mar- 
riage, or  whose  wives  are  exig^ant  of  their  uxorial  rights. 
Thus,  I  was  consulted  in  the  case  of  a  Hebrew  gentleman 
in  good  general  health,  although  somewhat  emaciated, 
and  who  found  it  impossible  to  escape  from  a  matri- 
monial engagement  into  which,  while  in  the  possession 
of  full  virile  power,  he  had  entered.  Trusting  that  his 
condition  might  not  be  as  bad  as  it  seemed,  and  indeed 
ignorant  of  the  extent  to  which  it  reached,  he  married 
and  came  to  New  York  with  his  wife  on  his  wedding 
tour.  The  morning  after  his  arrival  he  came  to  see  me 
in  a  state  of  great  mental  distress  and  with  the  informa- 
tion that  he  was  absolutely  incapable  of  doing  the  duty 
of  a  husband.  Upon  examination  I  found  the  testicles 
in  a  state  of  extreme  atrophy,  being  soft  and  not  larger 
or  thicker  than  a  twenty-five  cent  piece,  and  the  penis 
cold,  thin  and  extremely  flaccid.  The  general  emacia- 
tion was  not  extreme,  and  while  it  was  evident  that  the 
absorption  of  the  tissues  of  the  genital  organs  had  been 
more  rapid  than  that  of  other  parts  of  the  body,  I  could 


ABSENCE   OF   THE    POWER   OF    ERECTION.  I47 

discover  no  nervous  or  other  affection  of  the  parts  to 
account  for  the  state  in  which  they  were.  I  gave  an 
unfavorable  prognosis,  and  shortly  afterwards  the  mar- 
riage was  annulled  in  one  of  the  Courts  of  Pennsylvania, 
from  which  State  the  couple  came. 

In  another  case,  the  patient,  a  gentleman  who  had 
been  married  several  years  and  had  had  three  children 
by  his  wife,  became  the  subject  of  phthisis  and  of  rapid- 
ly advancing  emaciation.  With  the  decline  in  his  health 
there  was  also  a  rapid  loss  of  sexual  power,  due,  as  I 
found  on  examination,  to  atrophy  of  the  testicles.  These 
organs  were  soft,  flabby  and  not  more  than  one  half 
the  natural  size  when  the  patient  first  came  under 
my  observation.  The  penis  was  also  greatly  reduced 
in  size.  In  this  instance  there  were  extensive  demands 
made  on  the  patient's  generative  power,  with  which 
he  was  both  indisposed  and  unable,  even  with  the  best 
intentions  in  the  world,  to  comply.  The  prognosis 
was  bad,  and  the  patient  died  some  two  years  after- 
ward without  the  least  recuperation  of  the  procreative 
faculty. 

Local  emaciation  of  the  generative  organs  may  exist 
without  the  participation  of  the  system  at  large,  and  is 
then  due  to  some  cause  cutting  off  the  nervous  influence 
to  the  parts  or  depriving  them  of  their  due  supply  of 
blood.  Certain  brain  affections,  as,  for  instance,  cere- 
bral hasmorrhage,  are  sometimes  followed  by  atrophy 
of  the  testicles.  This  result  has  been  asserted  to  be  par- 
ticularly apt  to  ensue  from  injury  or  disease  of  the  cere- 


148  SEXUAL   IMPOTENCE   IN    THE   MALE. 

bellum.  Gall  *  observed  several  cases  of  the  kind,  and 
numerous  other  instances  are  referred  to  by  Combe,t 
and  other  writers.  Larrey,:}:  in  an  elaborate  paper^ 
sustains  Gall's  theory,  and  adduces  several  cases  in  its 
support.  In  injury  or  disease  of  this  part  of  the  en- 
cephalic mass  he  asserts  that,  though  in  the  beginning 
there  may  be  an  exaggeration  of  the  sexual  feeling  and 
power,  yet,  as  the  morbid  process  advances,  there  will 
be  a  state  of  decided  asthenia  of  the  genital  organs, 
combined  with  atrophy  of  the  testicle  of  the  side  cor- 
responding to  that  of  the  diseased  lobe  of  the  cerebel- 
lum, or  of  both  if  the  whole  of  this  part  of  the  cerebel- 
lum be  affected.  In  support  of  his  remarks  Larrey 
cites  the  case  of  a  young  soldier  who,  in  Egypt,  was 
struck  on  the  back  of  the  head  by  a  large  splinter  of 
wood.  Inflammation,  supposed  to  be  located  in  the 
cerebellum,  supervened.  He  eventually  so  far  recov- 
ered as  to  be  sent  back  to  France.  Several  years 
elapsed  before  he  again  came  under  Larrey 's  notice. 
It  was  then  found  that  his  genital  organs  were  reduced 


*  "Cerebello  vulnerato  partes  genitales  sympathiam  trahuntur.  Gall, 
V^indobonnae  Austriacorum,  duos  milites,  e  vulnerato  occipite,  impotentes 
fieri  observavit,  quorum  unus,  duobus  post  annis,  veneris  appetentiam  et 
copulandi  poteslatem  iterum  recepit,  puerosque  genuit.  Formey,  Bero- 
linensis  narravit  nobis  historian!  cujusdam  qui,  occipite  vulnerato,  primum 
priapismo,  dein  impotentia  vexatus  est.  Veruntamen  sex  post  mensibus 
virilitatatem  recuperavit."  "  Phrenology;  or,  the  Doctrine  of  the  Mental 
Phenomena."     By  J.  G.  Spurzheim.     Boston^  1833,  vol.  i,  p.  150. 

f  A  "  System  of  Phrenology."     Boston,  1834,  p.  no. 

X  "Observations  on  Wounds."  Translated  from  the  French  by  E.  F. 
Rivinus,  M.D.,  Phila.,  1832,  p.  199. 


ABSENCE   OF   THE   POWER   OF   ERECTION.  I49 

in  size  to  those  of  an  infant  a  few  months  old.  The 
power  of  erection  was  lost,  and  sexual  desire  had  dis- 
appeared. 

In  another  case  a  soldier  was  struck  by  the  ball  of  a 
blunderbus,  which,  grazing  the  occipital  protuberance, 
tore  away  the  extensor  muscles  of  the  head  in  its  pas- 
sage from  one  side  to  the  other.  The  patient  imme- 
diately felt  a  violent  pain  in  the  occiput,  and  a  sense  of 
weight  in  the  whole  head,  together  with  numbness  of 
the  lower  extremities.  His  vision  and  hearing  were  so 
much  impaired  that  he  could  hardly  discern  any  large 
objects  or  understand  the  most  piercing  words.  His 
testicles  became  reduced  and  wasted  away,  and  his 
penis  diminished  in  the  same  proportion  and  lost  the 
power  of  erection. 

The  third  case  was  that  of  a  man  who  had  received  a 
sabre-cut  through  the  occipital  bone  and  dura  mater, 
so  that  the  right  lobe  of  the  cerebellum  could  be  readily 
seen  and  touched.  When  the  finger  was  pressed  upon 
it  ever  so  gently,  vertigo,  syncope  and  convulsions 
were  induced,  but  no  pain  was  experienced.  After  the 
first  few  days  the  patient  lost  the  faculties  of  vision  and 
hearing  on  the  right,  or  opposite,  side.  At  the  same 
time  there  were  violent  pains  along  the  course  of  the 
spine,  and  a  kind  of  formication  in  the  testicles,  the 
size  of  which  rapidly  diminished,  so  that  in  less  than  a 
fortnight  they  were  reduced  to  the  size  of  small  beans. 
The  sexual  passion  became  utterly  extinguished. 

In  the  fourth  case  the  patient  was  struck  on  the  back 


150  SEXUAL   INPOTENCE   IN   THE    MALE. 

of  the  head  ;  among-  other  consequences  the  right  testi- 
cle became  atrophied  and  the  power  of  erection  was 
lost. 

In  the  fifth  case,  in  consequence  of  a  blow  on  the 
head  with  a  piece  of  wood,  an  abscess  of  the  right  lobe 
of  the  cerebellum  was  produced,  of  which,  in  about 
three  months,  the  patient  died.  The  post-mortem  ex- 
amination showed  entire  disorganization  of  the  right 
lobe  and  marked  atrophy  of  the  testicle  of  the  opposite 
side. 

In  the  sixth  case,  disease  of  the  cerebellum  was  the 
consequence  of  erysipelas.  The  patient  lived  two 
months.  Subsequently  the  post-mortem  examination 
revealed  the  existence  of  an  abscess,  which  had  en- 
tirely taken  the  place  of  the  left  lobe  of  the  cerebellum. 
The  scrotum  and  penis  were  so  much  reduced  from 
their  original  size  as  to  be  in  the  second  stage  of  atrophy. 

Three  remarkable  instances,  showing  the  connection 
between  cerebellar  lesions  and  atrophy  of  the  genital 
organs  have  been  reported  by  Dr.  John  D.  Fisher,^  of 
Boston. 

The  first  was  that  of  a  man  aged  forty-five,  who  was 
seen  soon  after  his  death,  which  took  place  from  pneu- 
monia. The  penis  was  small ;  the  glans  had  evidently 
seldom,  if  ever,  been  uncovered.  When  exposed  it 
was  small,  pale  and  pointed ;  all  the  parts  of  the  organ 
resembled  those  of  a  boy  not  yet  arrived  at  the  age  of 

* "  Contributions   Illustrative  of  the  Functions  of  the  Cerebellum." 

American  Jottrnal  of  the  Medical  Sciences,  Feb.,  1839. 


ABSENCE    OF    THE    POWER    (>F    ERECTION.  151 

puberty.  The  scrotum  was  soft  and  flabby,  and  was 
empty.     No  testicles  were  anywhere  to  be  found. 

The  head  was  large,  measuring  22  inches  in  circum- 
ference. The  brain  was  healthy  and  very  large,  weigh- 
ing $1^  ounces.  The  relative  proportion  of  the  cere- 
bellum to  the  cerebrum  was  much  reduced,  for  while 
the  latter  weighed  47  ounces,  the  former  weighed  but 
4^  ounces.  According  to  Meckel  and  others  the  aver- 
age weight  of  the  cerebrum  and  cerebellum  united  is 
48  ounces,  and  the  weight  of  the  cerebellum  to  that  of 
the  cerebrum  is  as  i  to  7  or  as  i  to  8.  In  this  case 
the  cerebellum  measured  in  its  transverse  diameter 
2^  inches,  and  in  thickness  i^-  inches;  antero-posteii- 
orly  2^  and  perpendicularly  2^  inches.  It  was  there- 
fore one-third  less  in  size  and  weight  than  is  ordinarily 
the  case  in  an  adult  male,  and  was  the  exact  weight  of 
that  of  a  female  child  six  years  old,  whose  body  was 
examined  at  the  same  time. 

The  history  of  the  patient  is  very  interesting.  The 
deficiency  of  testicles  was  discovered  by  Dr.  Warren. 
The  voice  was  like  that  of  a  woman  ;  he  had  no  beard  ; 
he  never  exhibited  any  amorous  propensities,  or  desire 
for  female  society  ;  as  his  mother  expressed  it,  he  was 
a  virgin  in  feeling  and    conduct  to  the  day  of  his  death. 

The  second  case  was  that  of  a  man  aged  forty-one, 
who,  while  a  passenger  in  a  railway  train,  was  injured 
by  a  collision,  so  that  the  back  part  of  his  neck  was 
struck  violently  against  the  window  frame  of  the  car. 
The  blow   was   so  severe  that  he    remained   for   some 


152  SEXUAL   IMPOTENCE    IN   THE    MALE. 

time  in  a  state  of  insensibility.  At  first  it  was  thought 
that  his  skull  was  fractured,  or  his  neck  dislocated. 
He,  however,  regained  his  intelligence  and  was  con- 
veyed to  his  residence.  Various  symptoms  connected 
with  the  nervous  system  supervened,  and  between  the 
fourth  and  fifth  weeks  after  the  accident  he  made  the 
discovery  that  he  had  lost  the  desire  for  sexual  inter- 
course and  the  power  of  erection.  The  ordinary  exci- 
tations failed  altogether  to  cause  any  amorous  feeling, 
and  this  condition,  he  was  of  opinion,  had  existed  since 
the  accident.  The  generative  function  continued  dor- 
mant for  two  3'ears,  and  six  months  later  was  only  par- 
tially active. 

The  following  case  is  particularly  interesting  owing 
to  the  fact  that  strong  venereal  desires  existed,  but 
in  consequence  of  deficient  power  they  could  not  be 
indulged.  It  is  related  by  Dr.  Whittemore,  but  is  re- 
ported bv  Dr.  Fisher  : 

An  old  man,  aged  seventy-three,  had  been  married 
forty  years,  and  had  had  eleven  children.  Soon  after 
marriage  he  began  to  complain  of  dizziness  and  noises 
in  the  head,  to  which  he  was  subject  more  or  less  till 
his  death.  In  addition,  he  had  intense  vertigo  and  se- 
vere pain,  together  with  partial  deafness  in  the  left 
ear.  Then  he  had  several  attacks  of  hemiplegia,  and 
after  their  occurrence  was  affected  with  morbid  salac- 
ity, which  continued  with  little  intermission  till  about 
three  months  before  his  death,  when  it  began  to  sub- 
side so  that  the  desire  became  imperious  but  once  or 


ABSENCE    OF    THE    POWER    OF    ERECTION.  1 53 

twice  during  the  night.  There  was,  however,  no  abil- 
ity to  gratify  it,  owing  to  imperfect  erection,  and  for  a 
year  there  had  been  no  seminal  emission. 

On  the  day  after  his  death  his  brairr  was  examined. 
The  dura  mater  was  adherent  to  the  skull,  the  arach- 
noid was  thickened,  there  was  a  large  quantity  of  ser- 
ous fluid  in  the  pia  mater,  and  the  arteries  were 
undergoing  ossification.  Otherwise  the  brain  was 
healthy,  except  as  regarded  the  cerebellum.  The 
right  lobe  of  this  organ  was  normal ;  the  left  lobe  was 
one-fifth  smaller,  and  was  found  to  have  lost  the  greater 
part  of  its  substance,  owing  to  the  formation  of  a  cavity 
in  its  tissue.  The  sides  of  the  cavity  were  in  contact, 
but  it  had  probably  contained  serum,  which  had  es- 
caped when  it  was  laid  open. 

Budge  *  found  that  by  irritating  the  cerebellum 
movements  of  the  testicles  were  produced.  Thus  he 
says: 

"  By  a  lucky  coincidence  I  made  the  gratifying  ob- 
servation that  in  an  old  cat,  whose  testicles  la}^  in  the 
abdominal  cavity,  these  organs,  immediately  after 
death,  moved  whenever  the  cerebellum  was  irritated 
by  the  scalpel  or  with  caustic  potash.  The  effect  was 
such  that  whenever  the  right  half  of  the  cerebellum 
and  the  right  half  of  the  vermiform  process  were  irri- 
tated, movements  of  the  left  testis  ensued,  and  the  re- 
verse. Mere  superficial  irritation  sufficed  to  produce 
this  result.     The  movements  of  the  testicles  soon  be- 

*  "  Untersuchungcn  Uber  das  Nervensystem."  Heft,  ii,  p.  82. 


154  SEXUAL   IMPOTENCE   IN   THE    MALE. 

came  so  palpable  in  this  animal  that  there  could  be  no 
doubt  as  to  its  reality.  I  hastened  to  open  the  entire 
skull  and  the  abdominal  cavity  and  found  the  testicles 
lying  perfectly  still  and  "vvithout  any  trace  of  move- 
ment. On  irritating  one  side  of  the  cerebellum  the  tes- 
ticle of  the  opposite  side  swelled,  quitted  its  position, 
and  rose  up  so  as  to  form  a  right  angle  with  the  sperm- 
atic cord,  one  side  of  the  angle  being  directed  forward. 
If  I  desisted  from  the  irritation,  the  testicle  returned  to 
its  position,  and  the  movement  was  renewed  on  renew- 
ing the  irritation.  The  experiment  was  repeated  dur- 
ing  half  an  hour  with  unvarying  results.  After  the 
first  irritation  not  three  seconds  elapsed  before  the 
movement  followed.  Subsequently  the  interval  be- 
tween the  irritation  and  the  effect  was  prolonged.  The 
movement  only  lasted  a  short  time  and  was  diminished 
more  and  more.  Alternately  with  the  cerebellum  I 
irritated  the  cerebrum,  the  corpora  quadrigemina,  the 
thalami  optici,  the  corpora  striata,  but  I  have  never 
seen  the  slightest  movement  result  from  the  irritation 
of  those  parts." 

Valentine  confirms  Budge's  observations,  but  Volk- 
mann  has  never  been  able  to  do  so,  and  Miiller  discred- 
its them  altogether. 

I  have  endeavored  to  satisfy  mvself  in  regard  to  these 
points  by  repeating  Budge's  experiments.  In  one  in- 
stance, in  which  a  cat  was  used,  decided  movements  of 
the  testicles  were  induced  by  irritating  the  cerebellum 
with  a  scalpel  or  with  the  continuous  galvanic  current 


ABSENCE   OF   THE   POWER   OF   ERECTION.  1 55 

applied  through  two  needles.  The  irritation  of  the  left 
lobe  produced  movements  in  the  right  testicle,  and 
vice  versa.  When  the  current  was  passed  through  both 
lobes,  both  testicles  were  moved  and  the  penis  was  also 
brought  into  a  state  of  erection.  I  was  at  first  disposed 
to  attach  considerable  importance  to  these  facts,  as  in- 
dicating a  very  close  relationship  existing  between  the 
cerebellum  and  the  generative  organs  ;  but  by  further 
observation  I  found  that  irritationof  the  medulla  oblon- 
gata and  of  the  cerebrum  produced  like  movements  in 
both  testicles  and  in  the  penis.  I  also  found  that  irrita- 
tion of  the  cerebellum  in  either  way  I  have  mentioned 
caused  movements  of  the  intestines,  of  the  abdominal 
muscles,  and  of  the  muscles  of  the  thigh  and  back. 
My  experiments  were  performed  upon  three  cats  just 
killed.  1  am  hence  disposed  to  attach  less  importance 
to  Budge's  observations  than  does  Romberg,*  who 
quotes  them  with  evident  approbation.  The}^  are  nev- 
ertheless interesting  as  showing  that  though  the  con- 
nection between  the  cerebellum  and  the  sexual  organs 
is  not  exclusive,  there  is  a  relation  in  which,  however, 
other  parts  of  the  body  participate  and  which  likewise 
exists  with  other  parts  of  the  brain.f 

There  are  various  affections  of  the  spinal  cord  which 


*  "A  Manual  of  the  Nervous  Diseases  of  Man."  Sydenham  Society's 
Translation.     Vol.  ii.  p.  33. 

f  My  experiments  were  performed  in  1856,  and  are  detailed  in  a  mono- 
graph on  "The  Physiology  and  Patholoary  of  the  Cerebellum,"'  read  be- 
fore the  New  York  County  Medical  Society.  January  4th,  1869.  and 
published  in  the  yotirnal  of  Psychologiiol  Medicine,  April,  iSOq,  p.  209. 


156  SEXUAL   IMPOTENCE   IN   THE   MALE. 

cause  sexual  impotence.  During  the  actively  inflamma- 
tory stage  of  these  diseases  there  is  often  intense  and 
long-continued  priapism,  but  as  the  morbid  process  ad- 
vances, loss  of  power  is  the  result.  Thus,  taking  loco- 
motor ataxia  as  an  example,  we  find  that  very  generally 
during  the  first  period  of  the  disease  there  is  an  exalta- 
tation  of  sexual  desire  and  power,  and  that  nocturnal 
emissions  are  frequent,  but  that  in  the  latter  stages  loss 
of  virility,  with  or  without  atrophy  of  the  testicles  and 
penis,  is  apt  to  occur. 

Diseases  or  injuries  of  the  nerves  supplying  the  gen- 
erative organs  may  lead  to  impotence  by  causing  atro- 
phy of  the  parts  concerned.  Among  these  may  be 
mentioned  severe  and  long-continued  neuralgia  of  the 
testis  or  of  the  cord,  degenerative  changes  in  the  sper- 
matic nerves,  or  tumors  or  other  growths  compressing 
them.  The  experiments  of  Obolensky  on  rabbits  go  to 
show  that  if  the  spermatic  nerve  be  divided  the  corrc' 
sponding  testicle  progressive!}'  wastes  away  and  in  a 
case  of  fatty  degeneration  of  the  nerve  occurring  in  a 
man,  the  testicle  of  the  same  side  was  atrophied.  In 
two  cases  of  neuralgia  of  the  testis  in  which,  for  their 
cure,  I  compressed  the  spermatic  cord  strongly,  there 
was  no  permanent  loss  of  power.  Neither  did  the 
pressure  cause  atrophy  of  the  testicle  corresponding  to 
the  side  on  which  the  operation  was  performed.* 


*"  Neuralgia  of  the  Testis."  Read  before  the  New  York  Neurologi- 
cal Society,  May  4th,  iS3o.  Neurological  Contributions,  No.  3,  1881, 
P-  35- 


ABSENCE   OF   THE   POWER   OF   ERECTION.  1 5/ 

The  effects  of  excessive  horseback  riding  in  causing 
atrophy  of  the  testicles,  and  consequent  impotence,  are 
well  known  to  writers  on  the  subject,  but  do  not  ap- 
pear to  have  attracted  the  attention  of  the  profession  at 
large.  In  a  recently  published  monograph*  I  had  oc- 
casion to  inquire  into  this  subject  and  will  bring  for- 
ward some  of  the  results  of  my  investigations. 

From  a  very  early  period  the  idea  has  existed  that 
the  male  inhabitants  of  the  Caucasus  are  subject  to  a 
peculiar  disease,  the  chief  characteristics  of  which  are 
the  loss  of  the  physiological  and  moral  attributes  of 
man,  the  supervention  of  impotence,  the  disappearance 
of  the  beard,  the  atrophy  of  the  penis  and  testicles,  and 
eventually  the  implication  of  the  mind  to  such  an  extent 
that  the  subjects,  believing  themselves  to  be  women, 
clothe  themselves  like  women  and  adopt  the  manners, 
customs,  and  occupations  of  the  female  sex. 

The  first  mention  of  the  condition  in  question  is  that 
by  Herodotus,t  who  states  that  when  the  Scythians 
were  about  leaving  Syria  and  Palestine,  which  they 
had  invaded,  their  rear  guard  pillaged  the  temple  of 
Venus  at  Ascalon.  The  goddess  was  so  enraged  at 
the  act  of  desecration  that  she  caused  the  perpetrators 
to  become  like  women,  and  further  decreed  that  their 
posterity  should  be  similarly  affected.  Herodotus  ac- 
cepts this  story  without  question. 

* "  The  Disease  of  the  Scythians  (Morbus  Foeminarum)  and  other 
Analogous  Conditions."  American  yourtial  of  Neurology  and  Psychiatry, 
August.  1882.  p.  339. 

f  "  History  of  Herodotus"  (Rawlinson's  Translation),  vol.  i.  p.  190. 


158  SEXUAL   IMPOTENCE   IN   THE    MALE. 

Hippocrates*  is  the  next  to  refer  to  the  matter,  and 
as  showing  to  what  causes  the  "Father  of  Medicine'' 
attributed  the  remarkable  disease  I  quote  his  observa- 
tions at  length  :  "  I  have  to  make  another  allusion,"  he 
says,  "  and  that  is  to  the  fact  that  among  the  Scythians 
many  impotent  persons  are  encountered,  who  occupy 
themselves  with  the  work  of  women  and  who  have  a 
like  pitch  or  tone  of  voice.  They  are  called  anandrii. 
The  natives  allege  that  the  phenomena  are  caused  by  a 
god,  and  they  venerate  and  worship  those  who  are 
thus  affected,  fearing  each  one  that  he  may  himself  be- 
come the  subject  of  a  like  visitation.  As  for  me,  I  re- 
gard this  disease  as  being  no  more  of  divine  origin 
than  any  other,  for  no  disease  has  any  pre-eminence  in 
this  respect.  Each  one  has  a  natural  cause,  and  no  one 
can  arise  without  the  intervention  of  nature.  Let  me 
state  what  appears  to  me  to  be  the  cause  of  the  affec 
tion. 

"  Horseback  riding  produces  with  the  Scythians  en- 
gorgements of  the  articulations,  because  the  limbs  are 
always  fianging  without  support.  With  those  who  are 
severely  visited  the  hip  is  drawn  back  and  they  are 
rendered  lame.  For  the  cure  of  this  deformity  they 
open  the  two  veins  which  are  near  the  ears.  When 
the  blood  has  ceased  to  flow  they  are  overcome  with 
weakness  and  fall  asleep.  On  awaking  some  are  found 
to  be  cured,  but  others  are  not.  I  presume  that  it  is 
exactly    by  this   treatment    that   the   seminal   fluid   is 

*  HEpi  depoDv,  vSccToaVy  roTfooy. 


ABSENCE   OF   THE    POWER   OF   ERECTION.  I  59 

changed,  for  near  the  ears  there  are  veins  which  ren- 
der impotent  those  in  whom  they  are  cut.  Now,  I 
think  that  the}^  divide  these  very  veins.  When  after 
this  operation  they  attempt  to  have  sexual  intercourse 
and  fail,  they  are  at  first  not  disquieted,  but  if  after 
two  or  three  more  trials  they  do  not  succeed,  they  im- 
agine that  they  are  being  punished  by  some  god  whom 
they  have  offended.  They  then  assume  the  attire  of 
women,  declare  that  they  have  lost  their  virility,  asso- 
ciate exclusively  with  women,  and  follow  like  occupa- 
tions. 

"This  disease  attacks  the  rich  and  not  the  lower 
classes.  The  noble  and  the  powerful  are  its  chief  vic- 
tims, because  they  go  much  on  horseback^  while  the 
poor  do  not.  .  .  It  is  also  met  with  in  other  people,  for 
when  equitation  is  the  chief  and  habitual  mode  of  ex- 
ercise  many  must  suffer  from  swellings  of  the  joints, 
with  sciatica  and  gout,  and  be  deprived  of  sexual  inter- 
course. These  infirmities  are  widespread  among  the 
Scythians,  who  are  the  most  impotent  of  men,  in  con- 
sequence of  the  cause  specified  and  by  reason  of  the 
fact  that  they  constantly  wear  breeches  and  pass  the 
greater  part  of  the  time  on  horseback.  Thus  they 
never  touch  the  genital  organs  with  the  hands ;  and 
subdued  by  cold  and  restrained  by  the  fatigue  attend- 
ant on  sexual  pleasures,  they  do  not  attempt  inter- 
course till  they  have  in  reality  lost  their  virile  power." 

It  will  be  seen,  therefore,  that  Hippocrates  attributes 
the  disease  under  notice  indirectly  to  horseback  riding: 


l60  SEXUAL   IMPOTENCE    IN    IHE    MALE. 

in  excess,  and  directly  to  the  division  of  veins  near  the 
ears,  which  he  supposes  to  be  in  intimate  relation  with 
the  generative  organs. 

Sprengel*  speaks  of  the  pretended  wise  men  among 
the  Scythians  who,  rendered  irritable  by  the  abstinence 
to  which  they  condemned  themselves,  fell  into  violent 
convulsions  whenever  they  wished,  or  whenever  the 
superstition  of  their  countrymen  required.  The  unin- 
telligible  words  which  they  spoke  while  m  this  state 
caused  them  to  be  regarded  as  prophets.  The  Greeks 
called  them  enares,  anandries,  either  because  their 
prejudices  obliged  them  to  avoid  intercourse  with 
women,  or  because  their  excessive  sensibility  really 
changed  their  constitutions,  and  rendered  them  unfit 
for  the  generative  act.  He  quotes  Reinegg,f  who  in 
his  description  of  the  Caucasus  says  : 

**  The  most  remarkable  of  all  the  nomadic  tribes  of 
the  Kuban  is  that  called  the  Nogays  or  Mongutays. 
The  members  of  this  are  distinguished  from  the  others 
by  the  Mongolian  features,  which  characterize  their 
entire  physical  structure.  The  men  are  obese,  large 
and  swollen,  the  cheek  bones  very  prominent,  the  eyes 
deep-sunken,  and  the  beard  sparse.  When  they  are 
reduced  by  disease,  or  when  they  have  attained  to  an 
advanced  age,  the  skin  of  the  whole  body  becomes 
wrinkled,  the  beard  disappears  altogether,  and  in  this 

♦  "  Histoire  de  la  M6decine"  (French  Translation  of  A.  J.  L.  Jourdan). 
Paris,  1815,  t.  I,  p.  207. 
f  "  Beschreibung  der  Kaukasus,"  St.  Petersburg,  1796,  Th.  i,  p.  26g. 


absEjNce  of  the  power  of  ekec'jion.        161 

sidte  they  present  a  great  resemblance  to  women. 
They  become  incapable  of  the  procreative  act,  and 
their  feelings  ns  well  as  their  actions  cease  to  be  like 
those  of  the  sex  to  which  they  belong.  Obliged  to  fly 
from  the  society  of  men,  they  seek  that  of  women, 
whose  dress  they  adopt." 

Jules  Klaproth,*  the  son  of  the  eminent  chemist,  has 
noticed  the  like  facts  in  the  Nogays  of  the  Caucasus, 
and  recognizes  the  accuracy  of  the  description  given 
by  Hippocrates,  and  which  I  have  already  cited. 

Chotomskif  is  authority  for  the  statement  that  there 
are  to  this  day  many  among  the  Tartars  of  the  Cau- 
casus who  are  affected  with  impotence  as  a  conse- 
quence of  excessive  riding  on  horseback. 

It  therefore  appears  that  there  is  good  reason  for 
believing  that  the  male  Scythians  of  an  early  day  and 
their  descendants,  the  inhabitants  of  the  Caucasus  of 
the  present  time,  are  particularly  subject  to  sexual  im- 
potence, and  that  this  condition  is  accompanied  with 
such  moral  and  physical  changes  in  the  affected  indi- 
viduals as  to  cause  them  to  look  like  women,  and  to 
acquire  the  mental  characteristics  and  instincts  of  the 
female  sex. 

There  seems  to  be  little  doubt  that  the  male  Scyth- 
ians were,  and  their  Tartar  descendents  of  the  present 
day  are,  extremely  addicted  to  the  vice  of  masturba- 

*  "  Reise  in  der  Caucasus,  und  nach  Georgien,"  Berlin,  1812,  Tli.  i.  p. 

285. 

f  Cited  by  Daremberg,  in  his  translation  of  Hippocrates,  Paris,  1843, 
p.  497. 


l62  SEXl'AI.    1MI'()TK.\c:K    ]X     IIIK    MALK. 

tion,  and  that  t!iey  are  als()  subject  to  seminal  losses 
not  directly  the  result  of  voluntary  acts.  And  this^ 
notwithstanding  the  circumstance  alleged  by  Hippo- 
crates that  the  constant  wearing  of  breeches  prevents 
them  carrying  their  hands  to  their  genital  organs. 
Sprengel  *  declares  that,  as  a  consequence  of  the  local 
excitement  due  to  continual  horseback  riding,  they  are 
not  only  subject  to  the  emissions  resulting  from  the 
friction,  but  that  they  practise  onanism  to  an  inordinate 
extent.  This  latter  habit  is  also,  doubtless,  aggravated 
by  the  circumstance  that  their  nomadic  life  deprives 
them  to  a  great  degree  of  the  ordinary  facilities  for 
sexual  intercourse,  women  not  accompanying  them  on 
their  forays  and  other  expeditions. 

A  similar  explanation  is  given  by  Lallemand.f  who 
reports  several  cases  'of  impotence  due  to  seminal 
losses  as  consequences  of  excessive  equitation.  Ac- 
cording to  him  the  friction  and  shocks  to  the  perineum 
resulting  from  contact  with  the  saddle  cause  irritation 
of  the  efferent  ducts,  thence  the  morbid  process  passes 
to  the  epididymis  and  the  testicles,  which  arc  kept  in 
an  almost  constant  state  of  erethism.  Emissions  result 
spontaneously,  and  the  condition  in  question  prompts 
to  the  frequent  commission  of  masturbation.  Impo- 
tence is  the  ultimate  consequence. 

Another  explanation  of  the  abolition  ol  sexual  power 
from  excessive   horseback  exercise  is  that  of  Darem- 

*"  .-Vpologie  der  Hippokrales."  Leipzig,  1792,  Part  ii.  p.  610. 
f  "  Des  pertes  sc-miiiales,"  Paris,  1836,  Part  i.  p.  581. 


ABSENCE   OF   THE    POWER   OF    ERECTION.  163 

berg,*  who  ascribes  it  to  the  pressure  exerted  upon 
the  spermatic  vessels  and  the  consequent  interruption 
of  the  due  course  of  their  nutrition,  and  the  loss  of  all 
procreative  desire  and  ability.  He  does  not  appear  to 
have  had  his  attention  drawn  to  the  erethism  of  the 
sexual  organs  produced  by  excessive  horseback  exer- 
cise. 

Under  the  heads  of  "  Eviration"  and  '*  Maladie  des 
Scythes,"  Nystenf  speaks  of  the  impotence  resulting 
from  inordinate  equitation.  It  produces,  he  declares, 
complete  loss  of  sexual  desire,  and  an  impossibility  of 
erection  in  men  who  are  otherwise  vigorous  and  in 
good  health.  Foresters  and  country  physicians,  who 
pass  a  good  deal  of  their  time  on  horseback,  are  men- 
tioned by  him  as  among  its  subjects.  The  habitual 
compression  of  the  vesiculse  seminales  and  of  the  pros- 
tate gland  appears  to  him  to  interfere  with  the  secret- 
ing process  of  the  semen. 

The  object  of  the  monograph  to  which  reference  has 
been  made  was  to  call  attention  to  the  fact  that  about 
thirty  years  ago,  while  stationed  in  New  Mexico  as  a 
medical  officer  of  the  army,  I  became  acquainted  with 
the  fact  that  the  Pueblo  Indians  are  in  the  habit  of  se- 
lecting some  one  male  from  among  those  living  in  a 
village  and  rendering  him  sexually  impotent,  reserving 
him  at  the  same  time  for  pederastic  purposes.  This 
person  was  called  a  mujerado,  a  corruption  probably  of 

*  Hippocrates  (Translation),  i  Paris.  1843,  Note  58,  p.  497. 

f  "  Dictionnaire  de  Medecine,"  etc.,  on/.ieme  edition,  Paris.  1S58. 


164  SKXUAL    IMPOTENCE    IN   THE    MALE. 

the  Spanish  word  niujeriego,  which  signifies  feminine 
or  womanish.  There  is  no  such  word  in  Spanish  as 
muj'erado,  but  if  there  were  it  would,  according  to  the 
construction  of  the  language,  mean  "womaned,"  or. 
"  made  like  a  woman." 

Two  of  these  creatures  came  under  my  observation. 
The  first  was  about  thirty-five  years  old,  rather  tall  and 
slim.  There  was  not  a  vestige  of  beard,  though  I  at- 
tached little  importance  to  this  fact,  as  the  Indians 
rarely  have  any  marked  growth  of  the  kind.  His 
countenance  was  cheerful  and  his  face  was  free  from 
wrinkles,  full  and  rounded,  like  that  of  most  Indian 
women  of  his  age.  He  was  dressed  exactly  like  a 
woman.  On  my  expression  of  a  desire  to  examine  him 
more  closely,  he  was  directed  to  accompany  me  into 
an  adjoining  room,  which  he  at  once  did,  the  chief  go- 
ing with  us.  He  then  at  my  request  removed  all  his 
clothing.  The  first  thing  that  attracted  my  notice  was 
the  extraordinary  development  of  the  mammary  glands, 
which  were  as  large  as  those  of  a  child-bearing  woman. 
He  told  me  that  he  had  nursed  several  infants  whose 
mothers  had  died,  and  that  he  had  given  them  plenty 
of  milk  from  his  breasts.  I  expressed  my  doubts  of 
the  truth  of  this  assertion,  but  he  pei'sisted  with  ve- 
hemence that  it  was  true.  The  chief  would  neither 
affirm  nor  deny  its  correctness,  repeating,  in  answer  to 
my  inquiries,  after  the  true  Mexican  fashion,  "  Quisas, 
quien  sabc  !'' — ("  Perhaps  so,  I  do  not  know.") 


ABSENCE    OF   THE    POWER    OE    EKECHOx\.  165 

The  abdomen  was  protuberant  and  the  limbs  were 
round,  full,  and  soft. 

Of  couse  the  most  importants  parts  to  be  inspected 
were  the  genital  organs.  There  was  no  hair  on  the 
pubis ;  the  penis  was  shrunken,  but  was  otherwise  nor- 
mal ;  the  prepuce  could  be  readily  retracted  and  the 
glans  presented  a  healthy  appearance,  except  that  it 
was  not  larger  than  a  thimble,  which  it  very  much  re- 
sembled in  shape.  The  whole  organ  was,  in  its  flaccid 
condition,  about  an  inch  and  a  half  in  length.  The  scro- 
tum was  long  and  pendulous  and  contained  the  remains 
of  the  testicles,  which  had  almost  entirely  disappeared. 
Each  one  was  the  size  of  a  small  filbert,  as  well  as  I 
could  judge.  Pressure  upon  them  gave  slight  pain.  I 
supposed  that  the  glandular  structure  had  become  al- 
most entirely  atrophied,  little  besides  connective  tissue 
remaining.  The  spermatic  cords  could  be  distinctly 
felt  up  to  the  external  abdominal  rings.  There  was 
slight  varicocele. 

In  all  other  respects  the  organs  were  normal,  there 
being  no  deformity  of  any  kind.  I  was  surprised  at 
this  condition,  for  I  had  expected  to  see  some  form  of 
hermaphrodism.  or  at  least  cryptorchism.  ' 

He  informed  me  that  he  had  been  a  mujerado  for 
seven  years,  and  that  previous  to  that  time  he  had  pos- 
sessed in  full  all  the  sexual  attributes  of  a  man.  First, 
his  testicles  had  begun  to  get  smaller,  and  with  their 
disappearance  he  had  lost  all  sexual  desire,  all  liking  for 


l66       SEXUAL  IMPOTENCE  IN  THE  MALE. 

the  companionship  of  men  and  for  their  ways,  and  had 
sousfht  the  society  of  the  women.  His  penis  had  not  at 
hrst  diminished  in  size,  but  as  it  gradually  lost  the 
poAver  of  erection  it  had  also  become  atrophied.  Before 
he  became  a  miijcrado  he  had,  as  he  informed  me  with 
evident  pride,  possessed  a  large  penis  and  his  testicles 
were  "■  grand es  coino  linevos" — as  large  as  eggs — a  state- 
ment which  the  old  chief  unhesitatingly  confirmed. 

His  voice  was  of  high  pitch,  thin  and  cracked,  es- 
pecially when  he  became  excited,  which  he  did  very 
readily  ;  and  he  indulged  in  more  gestulations  than  any 
Indian  I  had  ever  ?een. 

In  the  pueblo  of  Acoma,  about  twenty  miles  from 
Laguna,  I  ascertained  that  there  was  another  viujcrado. 
Accompanied  by  the  old  Laguna  chief  I  paid  a  visit  to 
this  village  in  the  autumn  of  185 1,  and  had  the  oppor- 
tunity of  making  a  thorough  examination  of  the  indi- 
vidual who  served  in  that  capacit3\ 

There  was  no  remarkable  development  of  the  mam- 
mary glands ;  the  pubis  was  devoid  of  hair  ;  the  penis 
was  greatly  shrunken,  not  being  over  an  inch  in  length 
when  flaccid,  and  of  about  the  circumference  of  the 
little  finger.  The  testicles  apparently  consisted  of 
nothing  but  connective  tissue,  as  no  pain  was  experi- 
enced on  strong  pressure  being  applied  to  the  soft  flat 
masses,  about  the  size  of  a  kidney  bean,  which  lay  at 
the  bottom  of  the  scrotum.  There  was  no  genital  de- 
formity of  any  kind  whatever. 

The  limbs  and  the  whole  body  were  lull  and  round- 


AHSENCE   OF   THP:    POWER    OF    ERECTION.  167 

ed,  and  there  was  not  a  sign  of  hair  anywhere  except 
on  the  scalp.  The  voice  was  shrill  and  weak.  As  he 
stood  naked  before  me,  the  whole  appearance  was  more 
that  of  a  woman  than  of  a  man.  When  he  put  on 
his  woman's  dress,  it  was  impossible  to  discover  any 
mark  of  difference  between  him  and  the  women  amonjr 
whom  he  lived.  He  was  apparently  about  thirty-six 
or  seven  years  old,  and  had  been  a  niujerado  for  nearly 
ten  3'ears. 

These  were  the  only  innjcrados  I  saw  in  New  Mexico^ 
though  I  was  told  that  every  pueblo  had  one,  or  even 
more.  Their  raison  aetre  is  evidently  to  be  found  in 
the  force  of  tradition,  which  still  exists  to  a  great  ex- 
tent with  the  Pueblo  Indians  of  New  Mexico.  In  re- 
ferring further  to  that  subject,  I  am  actuated  by  a  de- 
sire to  shed  as  much  light  as  possible  upon  a  custom 
and  its  results,  not  only  important  from  an  anthropo- 
logical but  a  neurological  point  of  view,  and  which  will 
doubtless  disappear  ere  long  before  advancing  civiliza- 
tion, even  if  they  have  not  already  done  so. 

I  found  it  very  difficult  to  ascertain  the  cause  of  the 
atrophy  of  the  genital  organs,  and  of  the  great  changes 
which  have  been  produced  in  other  parts  of  the  organ- 
ism, but  I  finally  succeeded  in  obtaining  some  informa- 
tion, which  was  certainly  correct  as  far  as  it  went,  for 
it  was  derived  from  several  authentic  sources,  includ- 
ing the  subjects  themselves,  and  was  uniformlv  to  the 
same  effect. 

A  mujcrado  is 'an  essential  person  in  the  saturnalia  or 


l68  SEXUAL   IMPOIEiNCE    I^f    THE    MALE. 

orgies,  in  which  tliese  Indians,  like  the  ancient  Greeks, 
Egyptians  and  other  nations  indulge.  He  is  the  chief 
passive  agent  in  the  pederastic  ceremonies,  which  form 
so  important  a  part  in  the  performances.  These  take 
place  in  the  spring  of  every  year,  and  are  conducted 
with  the  utmost  secrecy,  as  regards  the  non-Indian  part 
of  the  population.  For  the  making  of  a  ntujerado,  one 
of  the  most  virile  men  is  selected,  and  the  act  of  mas- 
turbation is  performed  upon  him  many  times  every 
day.  At  the  same  time  he  is  made  to  ride  almost  con- 
tinuously on  horseback.  The  genital  organs  are  thus 
brought  at  first  into  a  state  of  extreme  erethism,  so  that 
the  motion  of  the  horse  is  suf^cient  to  produce  a  dis- 
charge of  seminal  fluid,  while  at  the  same  time  the 
pressure  of  the  body  on  the  animal's  back — for  the  rid- 
ing is  done  without  a  saddle — interferes  with  their 
proper  nutrition.  It  eventually  happens  that  though 
an  orgasm  may  be  caused,  emissions  can  no  longer  be 
effected,  even  upon  the  most  intense  degree  of  excita- 
tion. Finally  the  accomplishment  of  an  orgasm  be- 
comes impossible.  In  the  meantime  the  penis  and 
testicles  begin  to  shrink,  and  in  time  reach  their  low- 
est plane  of  degradation.  Erections  then  altogether 
cease. 

But  the  most  decided  changes  are  at  the  same  time 
going  on  little  by  little  in  the  instincts  and  proclivities 
of  the  subject.  He  loses  his  taste  for  those  sports  and 
occupations  in  which  he  formerly  indulged,  his  courage 
disappears,  and    he    becomes  timid   to  such  an  extent 


ABSKN'CK    OF   TIIK    POWER    OF    EKECIION.  169 

that  if  he  is  a  man  occupying  a  prominent  place  in  the 
councils  of  the  pueblo  he  is  at  once  relieved  of  all  power 
and  responsibility,  and  his  influence  is  at  an  end.  If  he 
is  married,  his  wife  and  children  pass  from  under  his 
control,  whether,  however,  through  his  wish  or  theirs, 
or  by  the  orders  of  the  council,  1  could  not  ascertain. 
They  certainly  became  no  more  to  him  than  other 
women  and  children  of  the  pueblo. 

At  the  same  time  no  disgrace  attaches  to  the  condi- 
tion of  the  ))iujcrado.  He  is  protected  and  supported 
by  the  pueblo,  is  held  in  some  sort  of  honor,  and  need 
not  work  unless  he  chooses.  Men,  however,  do  not  as- 
sociate with  him,  but  this  is  more  in  accordance  with 
his  wishes  and  inclinations  than  from  any  desire  on 
their  part  to  avoid  him. 

Indeed,  his  endeavor  seems  to  be  to  assimilate  him- 
self as  much  as  possible  to  the  female  sex,  and  to  get  rid 
as  far  as  may  be  of  all  the  attributes,  mental  and  physi- 
cal, of  manhood.  Nevertheless,  the  condition  is  one 
which  is,  I  believe,  forced  upon  him  by  the  power  of 
tradition,  custom  and  public  opinion,  and  which — recog- 
nizing the  impossibility  of  escape — he  assumes  probably 
with  reluctance  in  the  first  instance,  but  eventually 
with  entire  complaisance  and  assent. 

I  could  not  ascertain,  with  any  degree  of  certainty, 
whether  the  inujcrados  were  public  property  for  peder- 
astic  purposes  at  an}*  other  times  than  at  the  annual 
orgies,  but  I  am  inclined  to  think  that  the  chiefs  or  some 
of  them  have  the  right  so  to  employ  them,  and  that  they 


170  SEXUAL    IMPOTENCE    IN    THE    MALE. 

do  avail  themselves  of  the  privilege.  They  avoided  all 
reference  to  the  subject,  and  professed  the  most  com- 
plete ignorance  of  the  matter  when  I  questioned  them 
directly  thereon.  The  old  chief,  however,  who  acted 
as  my  escort,  while  not  disposed  to  be  communicative, 
was  not  altogether  reticent  on  this  point,  and  admit- 
ted, by  unmistakable  signs  and  with  perfect  equanimitv, 
that  he  himself,  in  his  younger  days,  had  made  use  of 
the  uinjcrado  of  his  pueblo  in  the  manner  referred  to. 

The  difference  between  the  uinjcrados  and  the  enans, 
as  Herodotus  calls  them,  of  the  Scythians,  consists 
chiefly  in  the  fact  that  the  deprivation  of  virility  is  in- 
tentionally produced  for  a  specific  purpose  in  the 
Pueblo  cases,  while  in  the  ScN'thians  it  is  the  incidental 
result  of  customs  and  other  factors  which  exist  among 
the  people.  As  a  whole,  I  am  quite  sure  that  it  is  in 
both  instances  due  to  causes  of  similar  character. 

The  Pueblo  Indians  appear  to  recognize  the  influence 
of  horseback  riding  as  an  efficient  aid  in  their  process 
for  making  a  uiujcrado.  It  is  certainly  true,  as  1  know 
from  my  own  observations,  that  the  nomadic  American 
Indians,  who  are  the  representatives  of  the  Scythians 
on  the  Western  Continent,  especially  the  Apaches  and 
Navajos,  possess  small  generative  organs  and  limited 
sexual  desire  and  power.  From  their  very  infancy 
they  are  accustomed  to  the  use  of  the  horse  for  going 
even  the  shortest  distances.  They  rarely  walk  unless 
to  the  places  where  their  horses  are  hitched,  and  they 
keep  them  generally  within  arm's  reach  ;  I  have  seen 


ABSENCE   OF   THE    POWER   OF   ERECTION.  171 

them  mount  a  horse  to  ride  twentj-five  feet  to  get  the 
saddle  ;  one  of  the  consequences  of  this  practice  is  the 
arrest  of  development  in  the  muscles  of  the  lower  ex- 
tremities, their  thighs  are  attenuated  and  their  calves 
are  as  flat  as  the  hand.  They  are  entirely  incapable  of 
long  foot  marches. 

While  I  have  no  statistics  or  very  definite  informa- 
tion on  the  subject.  1  am  quite  sure  that  impotence  is 
common  among  them.  I  have  often,  when  they  had 
ascertained  that  I  was  a  "  medicine  man,"  had  young 
and  apparently  otherwise  vigorous  and  healthy  men 
beg  me  to  give  them  some  "  strong  medicine"  to  restore 
their  virile  power,  and  I  am  aware  that  the  major  part 
of  the  "  pow-wowings"  of  their  own  "medicine  men" 
is  undertaken  for  the  same  purpose.  An  Apache  or 
Navajo  woman  with  more  than  two  or  three  children 
would  be  a  curiositv  among  them. 

I  have  alreadv  spoken  of  the  probable  object  had  in 
mind  in  the  creation  of  the  vuijerados.  It  is  not  at  all 
improbable  that  the  subjects  of  the  "  Disease  of  the 
Scythians"  have  from  the  earliest  period  been  used  for 
a  like  purpose.  Bouhier*  asserts  that  they  are  the  pas- 
sive agents  in  pederasty,  and  that,  therefore,  they  cor- 
respond to  \h.t  pathici  of  the  ancients,  and,  I  may  add, 
to  the  mujerados  of  the  Pueblo  Indians.  A  like  view  is 
held  by  Rosenbaum,t  who  regards  the  disease  as  also 
being  produced  by  the  practice  in  question,  which  is  at 

*  "  Recherches  et  dissertations  sur  Hferodote,"  Dijon,  1746,  p.  240. 
f  "  Geschichte  der  Lustseuche,"  Halle,  1837,  t.  i,  p.  141. 


lyi  SEXUAI,    IMPOTENCE    IN   THE    MALE 

the  same  time  therefore  cause  and  effect.  Interesting 
and  important  data  relative  to  the  mental  and  physical 
changes  in  the  organism  which  result  from  this  vice  are 
given  by  Tardieu,*  Legrand  du  Saulle,f  Moreau  %  (de 
Tours),  Godard,§  and  other  writers  on  sexual  aberra- 
tion, and  the  question  is  also  discussed  in  its  relations 
to  impotence  in  the  immediately  preceding  chapters  of 
the  present  work. 

Certain  tnedicines  have  the  power  of  lessening  or  de- 
stroying the  sexual  power  of  the  individual  to  whom 
the}'  are  administered.  Among  them,  and,  according 
to  some  authors,  one  of  the  most  efficient  in  this  direc- 
tion, is  iodine  a?id  its  con/poiiuds. 

Iodine  is  usually  given  in  the  form  of  the  iodide  of 
potassium,  and  very  often  has  to  be  continued  for  long 
periods  and  in  extremelv  large  doses.  But  the  pure 
drug  is  not  infrequently  administered  in  the  form  of 
Lugol's  solution,  by  inhalation  of  the  vapor  or  by  ab- 
sorption through  the  skin. 

Roubaud  I  states  that,  having  given  the  vapor  of 
iodine  by  inhalation  in  the  treatment  of  phthisis,  he  ha? 
observed  four  cases  of  impotence,  with  more  or  less 
atrophy  of  the  testicles,  supervening  during  or  imme- 
diately after  the  treatment.     In  one  of  these  cases,  not 


*"  Etude  medico-legale   sur    les  attentats  aux   mceiirs,"   7th  edition, 
Paris,  1878. 
f  "Trait6  de  medccine  legale,"  Paris,  1S74. 

X  "  Des  aberrations  du  sens  genesique,"  2d  edition.  Paris,  1880. 
§  "  Egypt  et  Palestine,"  Paris,  1867. 
(  "  Traite  de  rimpuissance,"  etc.,  Paris,  1876,  p.  244. 


ABSENCE    OE   THE    POWER    OF    ERECTION.  I73 

withstanding  the  impossibilit}'  of  erection,  the  venereal 
desire  remained ;  and  the  testicles  preserved  almost 
their  normal  volume  in  the  instances  of  the  three  others, 
in  which  there  was  very  decided  atrophy  of  the  tes- 
ticles; the  sexual  indifference  was  well  marked,  they 
had  neither  desire  nor  power,  and  they  only  sought 
medical  advice  in  order  to  be  able  to  perform  their 
marital  duties  or  to  have  children. 

The  iodide  of  potassium  is  not  so  powerful  an  agent 
as  the  uncombined  drug  in  producing  impotence  and 
atrophy  of  the  testicles ;  nevertheless,  there  is  no  doubt 
of  its  power  in  this  respect.  Roland*  cites  two  cases 
in  which  its  influence  was  very  distinctly  manifested. 

In  a  debate  which  took  place  before  the  Academy  of 
Medicine  of  Paris,  RiUiet  asserted  that  the  effect  of 
iodine  and  its  compounds,  when  long  continued,  was  to 
cause  atrophy  of  the  mammary  glands  in  females  and  of 
the  testicles  in  males.  This,  however,  was  denied  by 
Ricord,  Piorry,  Velpeau  and  others.  Probably  few 
physicians  have  administered  the  iodide  of  potassium 
in  larger  doses  and  for  longer  periods  than  have  I,  and 
yet  I  have  never  known  it  to  produce  either  of  the  ac- 
cidents mentioned.  I  have,  however,  often  observed  a 
diminution  of  both  the  sexual  desire  and  the  power 
while  the  medicine  was  being  administered,  but  these 
effects  disappeared  soon  after  the  administration  of  the 
remedy  was  stopped. 

*  "  BuHetin  de  I'Acadfemie  Imperiale  de  Mfedecine,"  t.  xxv.  185;  i860; 
p.  382,  et  seq. 


174  SEXUAL   niPOTENCE    IN   THE    MALE. 

Nitrate  of  potash,  though  not,  so  far  as  I  know,  caus- 
ing atrophy  of  the  genital  organs,  is  certainly  a  power- 
ful anaphrodisiac,  and  when  given  for  a  long  time  to 
persons  in  good  sexual  health  may  abolish  both  the 
desire  and  the  power  of  the  individual.  Having  em- 
ployed it  several  years  ago  in  a  case  of  satyriasis,  in 
consequence  of  its  use  being  recommended  by  MM. 
Grimaud  de  Caux  and  Martin  Saint-Ange,  I  was 
not  greatly  surprised  to  see  the  effect  in  causing 
sexual  impotence  to  two  male  patients  to  whom  I  gave 
it  during  a  continuous  period  of  six  months  for  epilepsy. 
The  case  cited  by  the  authors  named  is  an  instructive 
one,  and  the  description  will  bear  translation  into  Eng- 
lish. 

"A  musician,  of  athletic  build  and  florid  complexion, 
and  of  an  emotional  temperament,  was  so  urged  by 
amorous  desires  that  the  sexual  act,  although  repeated 
several  times  in  the  course  of  a  few  hours,  did  not  suf- 
fice to  cool  his  ardor.  Hateful  to  himself,  he  feared 
the  chastisement  which  divine  anger  inflicts  on  those 
who  devote  themselves  to  a  life  of  voluptuousness,  and 
came  to  ask  m}-  help.  I  bled  him,  subjected  him  to  3 
course  of  cooling  and  calming  medicine,  and  imposed  a 
light  diet,  from  all  of  which  he  received  no  benefit.  My 
advice  then  was  that  he  should  marry,  and  he  espoused 
a  strong,  robust  daughter  of  a  villager.  At  first  he  ap- 
peared to  be  better,  but  in  a  short  time  his  wife  suffered 
so  greatly  from  his  repeated  embraces  that  he  returned 
to  his  former  course  of  life.     Coming  to  me  for  further 


ABSENCE    OF    THE    PO\N  ER    OF    ERECTION.  1 75 

relief  1  advised  fasting  and  praver,  but  these  proving- 
equallv  unsuccessful,  he  desired  castration.  This,  how- 
ever, 1  was  unwilling  to  perform  ;  but  he  was  very 
anxious  for  the  operation,  and  sought  to  gain,  by  pres- 
ents, the  consent  and  approval  of  those  who  opposed 
his  wishes.  He  promised  a  horse  that  could  amble 
beautifully,  and  whose  value  was  not  to  be  disdained, 
if  I  would  accede  to  his  wishes. 

"  I  declare  that  my  servants — not  knowing  the  na- 
ture of  his  wish,  and  unacquainted  with  his  satyr-like 
performances — have  often  made  me  blush  when  they 
would  request  me  to  do  as  the  poor  man  wished.  Little 
did  the}'  suspect  that  he  wanted  me  to  cut  out  the 
organs  that  made  him  a  man. 

"  In  thinking  of  the  means  that  might  cure  this 
musician,  I  recollected  that  I  had  heard  the  illustrious 
Prevatius  sav  that  he  had  with  nitre  cured  a  man  who 
suffered  with  nephritic  pains  due  to  the  presence  of  a 
calculus.  The  patient  was  cured,  but  he  became  in- 
capable of  enjoying  the  pleasui"e  of  love.  I  resolved  to 
make  use  of  this  remedy,  so  morning  and  night  I  gave 
him  nitre  dissolved  in  cav  de  nymphcea.  The  use  of  this 
salt  for  eight  days  reduced  him  to  such  a  state  of  indif- 
ference, that  he  hardly  sufificed  for  the  wants  of  his 
wife."  * 

In  the  instances  in  my  own  practice  to  which  I  have 
referred,  the  use  of  fifteen  grains  of  nitrate  of  potash 

*  Cited    by   MM.    Grimaud   de  Caux   and    Martin    Saint-Ange,    from 
Baldassar  Timeus.      Cas  Me  J.,  Lib  iii.,  Salad  tas  nitro  crtrata. 


176  SEXUAL   IMPOTENCE   IN   THE   MALE. 

three  times  a  day  produced  a  gradual  loss  of  sexual 
desire  and  power  in  both  patients  which  at  the  end  of 
a  month  was  complete.  It  was  nearly  a  year  after  the 
cessation  of  the  administration  of  the  drug  before  the 
normal  condition  was  regained. 

Alcoholic  liquors,  if  taken  very  sparingly,  perhaps  ex- 
ercise a  stimulating  influence  over  the  genesic  function, 
but  if  very  moderate  limits  be  exceeded  the  result  is 
impotence  of  a  more  or  less  permanent  and  profound 
character,  according  to  the  extent  of  the  excess. 

Generally  the  desires  and  power  both  diminish  or 
entirely  fade  away,  but  in  some  cases  desire  remains 
without  the  ability  to  accomplish  the  sexual  act  in  an 
entirely  satisfactory  manner.  Either  erections  fail  alto- 
gether and  intromission  becomes  impossible,  or  there 
are  imperfect  erections  and  premature  emissions.  In- 
tercourse attempted  during  a  state  of  intoxication  is 
scarcely  ever  performed  in  a  normal  manner,  and  the 
individual,  after  a  period  of  alcoholic  indulgence,  is 
generally  incapable  of  physiological  copulation  for 
several  days  thereafter.  Repeated  and  long  continued 
acts  of  dissipation  may  often  lead  to  absolute  and  per- 
manent loss  of  the  ability  to  have  intercourse.  In  many 
of  these  cases  the  venereal  appetite  is  not  abated;  on  the 
contrary  it  may  be  notably  increased,  and  then  the  in- 
dividual, not  being  able  to  satisfy  himself  in  a  legitimate 
way,  resorts  to  masturbation,  which  he  performs  with  a 
vehemence  and  frequency  almost  amounting  to  fury. 
I  have  seen  a  great  many  habitual  drunkards,  but  never 


.ABSENCFi    OF    THE    I'OWER    OF    ERKCTIOX.  i;; 

one  in  whose  case  the  investigation  was  made  who  was> 
not  a  masturbator  and  sexually  impotent. 

Most  physicians  whose  practice  is  largely  in  the 
direction  of  diseases  of  the  nervous  system  have  noticed 
the  decided  influence  of  the  bromides  in  causing  a  loss 
of  virile  power.  Tn  cases  of  epilepsy  some  one  of  the 
bromide  salts  is  given  often  for  several  years  without 
interruption,  and  it  is  almost  invariably  the  case  that 
:i[ter  a  few  months  the  desire  and  power  begin  to  be- 
come less.  Occasionally  the  effects  are  permanent,  but 
usually  when  the  administration  of  the  drug  has  ceased 
the  normal  state  returns,  especially  if  proper  remedies 
be  given.  In  one  case  under  my  charge  there  was 
iitroph}-  of  the  penis  and  testicles.  When  this  con- 
dition ensues  a  restoration  is  impossible. 

There  are  other  remedies  and  some  substances  used 
ns  food  which  are  said  to  have  the  power  of  causing 
diminished  sexual  power,  but  the  reputation  rests,  I 
ihink.  on  insufficient  evidence.  Among  the  former, 
however,  may  be  mentioned  lead,  antiDiony,  arsenic,  sul- 
phide of  carbon,  coniiim,  camphor,  and  many  others. 
Some  of  these,  notably  conium  and  camphor,  have  the 
effect  of  moderating  the  reflex  excitability  of  the  repro- 
ductive system,  but  they  in  no  sense  cause  impotence. 

Among  the  substances  used  as  food,  lettuce,  sorrcL 
cucumbers,  and  parsley  are  said  by  some  to  have  an  an- 
aphrodisiac  property,  but  I  have  never  observed  any- 
thing in  their  action  to  lead  me  to  accept  this  view  of 
their  influence. 


I7S  SKXUAI.    IMI'O  TKNCK    iX    THE    MAf.K. 

Cas/raiioii. —  It  might  reasonably  be  supposed  that 
the  operation  of  castration,  bv  depriving  a  man  ot  llic 
glands  which  secrete  the  semen,  would  invariably  ren- 
der him  incapable  of  sexual  intercourse,  but,  as  a  matter 
of  fact,  such  is  by  no  means  the  certain  effect  of  the 
procedure.  Of  course  the  removal  always  renders  the 
individual  sterile,  but  this  is  a  very  different  thing,  re- 
lating as  it  does  solely  to  the  taking  away  of  the  powei- 
to  procreate  children.  The  women  of  ancient  Rome 
were  well  acquainted  with  the  sexual  power  sometimes 
possessed  by  eunuchs,  and  knowing  them  to  be  sterile. 
knew  also  that  they  could  make  use  of  them  to  satisfv 
their  libidinous  desires  without  much  fear  of  detection. 
Indeed,  so  well  is  the  fact  of  their  occasional  virile  power 
known  in  Egypt  and  other  countries  in  which  eunuchs 
are  made,  that  not  infrequently  the  whole  generative 
apparatus  is  amputated,  in  order  to  prevent  the  pos- 
sibility of  sexual  intercourse  being  performed. 

Mental  causes. — There  are  certain  mental  causes  of  a 
failure  of  sexual  power  which  are  among  the  most  in- 
fluential of  all  for  the  time  being,  but  which,  in  general, 
are  not  difficult  to  manage,  inasmuch  as  they  do  not 
depend  upon  any  physical  disorder.  Among  these  are 
the  following  : 

Excessive  desire. — This  is  a  not  infrequent  cause  with 
the  newly  married  man  who  finds  himself  utterly  unable 
to  obtain  an  erection,  notwithstanding  the  fact  of  the 
strong  desire  by  which  he  is  actuated.  In  the  intervals 
of  his  attempts  his   erections  are  not  wanting  in  vigor. 


ABSENCE    OE    'I'HE    I'dWEK    OF    KRKC  IIOX.  179 

but  as  soon  as  he  endeavors  to  avail  himself  of  his 
rights  the  penis  becomes  flaccid  and  intromission  is  an 
impossibility.  Frequently  a  feeling  of  anxiety  or  doubt 
arises  in  the  mind  relative  to  the  success  of  the  act,  and 
this  adds  greatly  to  the  probability  of  an  unfavorable 
result.  John  Hunter, ■••  in  referring  to  this  influence, 
cites  the  following  case : 

''  A  gentleman  told  me  that  he  had  lost  his  virility. 
After  about  an  hour's  investigation  of  the  case,  I  made 
out  the  following  facts:  That  he  had  at  unnecessary 
times  strong  erections,  which  showed  that  he  had 
naturally  this  power  ;  that  the  erections  were  accom- 
panied with  desire,  which  are  all  the  natural  powers 
wanted  ;  but  that  there  was  still  a  defect  somewhere, 
which  I  supposed  to  be  from  the  mind.  I  inquired  if  all 
women  were  alike  to  him.  His  answer  was  no.  Some 
women  he  could  have  connection  with  as  well  as  ever. 
This  brought  the  defect,  whatever  it  was,  into  smaller 
compass,  and  it  appeared  that  there  was  but  one  woman 
that  produced  this  inability,  and  that  it  arose  from  a 
desire  to  perform  the  act  with  this  woman,  and  which 
desire  produced  in  the  mind  a  doubt  or  fear  of  the  want 
of  success,  which  was  the  cause  of  the  inability  of  per- 
forming the  act.  As  this  arose  entiiely  from  the  state 
of  the  mind,  produced  by  a  particular  circumstance,  the 
mind  was  to  be  applied  to  for  the  cure,  and  I  told  him 
that  he  might  be  cured  if  he  could  perfectly  rely  upon 
his  own  power  of  self-denial.     When  I  explained  what 

*  "A  Treatise  on  the  Venereal  Diseases,"  Phila.,  1S59,  p.  261. 


l8o  SEXUAL   IMPOTENCE    IX   THE    MALE. 

i  meant,  he  told  me  that  he  could  depend  upon  everv 
act  of  his  will  or  resolution.  I  then  told  him  that  if  he 
had  a  perfect  confidence  in  himself  in  that  respect,  that 
he  was  to  go  to  bed  to  this  woman,  but  first  promise 
to  himself  that  he  would  not  have  any  connection  with 
her  for  six  nights,  let  his  inclinations  and  powers  be 
what  they  would,  which  he  engaged  to  do,  and  also  to 
let  me  know  the  result.  About  a  fortnight  after  he  told 
me  that  this  resolution  had  produced  such  an  alteration 
in  the  state  of  his  mind,  that  the  power  soon  took  place ; 
for,  instead  of  going  to  bed  with  fear  of  inability,  he 
went  with  fears  that  he  should  be  possessed  with  toe 
much  desire,  too  much  power,  so  as  to  become  uneasv 
to  him,  which  really  happened ;  for  he  would  have 
been  happy  to  have  shortened  the  time,  and  when  he 
had  once  broke  the  spell  the  mind  and  powers  went  on 
tosfether,  and  his  mind  never  returned  to  its  former 
state." 

The  device  of  setting  up  a  different  line  of  thought 
or  of  emotion  from  that  w^hich  fills  the  mind,  will  gen- 
erally succeed  in  cases  such  as  the  foregoing.  In  the 
case  of  the  recently  married  man,  the  old  prescription 
of  bread  pills  will  suffice  to  restore  the  supposed  loss  of 
power  as  well  as  anything  else  in  which  the  patient  has 
confidence,  or  the  mere  direction  to  wait  patientlv,  the 
assurance  that  the  trouble  is  simply  transitory,  and  the 
explanation  of  its  cause,  will,  with  a  sensible  person, 
prove  equally  efficacious.  Most  of  the  cases  cure  them- 
selves in  a  few  davs  at  farthest. 


ABSENCE    OK    THE    POWER    OF    ERECTION.  l8l 

Fear,  irom  whatever  cause  arising,  is  a  very  powerful 
factor  in  temporarily  producing-  impotence,  and  one 
whicii  often  causes  a  more  or  less  permanent  loss  of 
sexual  power.  The  individual  engaged  in  illicit  rela- 
tions, with  the  apprehension  of  detection  constantlv 
before  him,  fails  at  the  moment  he  attempts  intercourse, 
from  the  absolute  inability  to  maintain  an  erection  ;  and. 
indeed,  any  emotion  will,  if  strongly  felt,  almost  invari- 
ably lead  to  a  like  result.  A  gentleman  once,  a  mem- 
ber of  the  volunteer  fire  department,  informed  me  that 
he  was  for  several  years  practically  impotent  at  night, 
for  the  reason  that  he  never  went  to  bed  without  the 
expectation  of  being  called  up  to  go  to  a  fire,  and  the 
anxiety  effectually  prevented  his  having  intercourse,  al- 
though his  desire  was  strong. 

The  effect  of  superstition  in  causing  impotence  is  even, 
in  our  times,  occasionally  exhibited.  In  a  former 
period  this  influence  was  more  generally  admitted,  and 
it  was  supposed  that  witches  and  sorcerers  had  the 
power  of  casting  a  spell  upon  a  man,  and  bv  this  means 
to  deprive  him  of  the  ability  to  accomplish  the  act  of 
sexual  intercourse.  These  individuals  were  in  France 
known  as  the  noueurs  d'aiguillette,  "  the  tiers  of  the 
knot.'"  All  that  was  necessary  was  that  the  person 
upon  whom  they  pretended  to  impose  their  spell  should 
thoroughly  believe  in  it,  and  the  impotence  was  an  ac- 
complished fact.  Cases  of  the  kind  were  a  very  com- 
mon occurrence,  so  that  after  a  while  every  man  who 
found  his  virile  powers  becoming  weaker  laid  the  cause 


l82  SKXUAI.    IMPOTEXCK    IX    THE    MALE. 

up(jn  some  old  man  or  woman  who  had  the  reputation 
of  b^ing  a  sorcerer  oi"  witch.  Many  uf  these  poor 
wretches  were  burned  at  the  stake  or  otherwise  se- 
verely punished  for  this  supposed  crime. 

The  extent  to  which  notions  of  the  kind  prevail  at  the 
pi'esent  day  is  scarce h'  known  among  educated  per- 
sons. Physicians,  however,  often  meet  with  cases  of 
purely  imaginarv  impotence,  which  the  subject  relig- 
iously believes  has  been  produced  b}'  an  enemy,  by  a 
look  or  an  incantation  of  some  kind,  or  bv  causing  him 
to  eat  some  particular  substance  which  has  had  the 
power  conferred  uDon  it  of  deprivino-  him  of  his  sexual 
functions.  The  consequence  ^i^  that,  actuated  by  the 
belief  which  he  entertains,  the  attempts  at  intercourse 
result  in  failure,  and  hence  he  ceases  to  make  any  fur- 
ther efforts  in  this  direction. 

Only  a  short  time  ago  a  man  consulted  me  for  im- 
potence with  which  he  believed  his  wife  had  affected 
him  so  as  to  keep  him  continent  during  a  visit  he  was 
about  to  make  to  New  York.  She  had,  he  said,  given 
him  a  singular  glance  as  he  left  the  house.  He  felt 
a  peculiar  thrill  pass  down  his  spine  to  his  testicles, 
and  after  that,  erection  was  impossible. 

In  another  case  a  man  from  Long  Island  came  to  see 
me,  bringing  a  lock  of  the  hair  of  a  woman  who,  he  be- 
lieved, had  "  laid  a  spell"  on  him  bv  which  he  was  ren- 
dered impotent.  The  woman  in  question,  he  explained, 
had  wished  him  to  marry  her.  He,  however,  had  fixed 
his  affections  on  another  woman,  and  had  married  her, 


ABSENCE    OF    THE    J'OW  ER    OF    EKECTIOX.  1 83 

whereupon  the  first,  oul  of  revenge,  had  caused  the 
loss  of  his  sexual  power.  Tlie  event  had  taken  place 
on  the  fifth  night  after  marriage.  Up  to  that  time  he 
had  done  his  part  to  his  entire  satisfaction,  but  on  the 
fifth  night,  the  disappointed  woman,  concealing  her 
jealousy,  had  invited  him  and  his  bride  to  take  tea  with 
her,  and  on  their  return  home  he  found  himself  in  the 
condition  mentioned.  He  had  been  told  that  I  could 
cure  him  by  treating  a  lock  of  the  hair  of  the  witch, 
and  with  much  trouble  he  had  succeeded  in  procuring 
this,  in  his  opinion,  indispensable  prerequisite  to  cure, 
gnd  had  brought  it  to  me. 

wSuch  cases,  unless  the  patient  can  bring  to  bear  a 
little  common  sense  on  the  subject,  are  apt  to  pass  on 
into  a  hvpochondriacal  condition,  in  which  the  whole  at- 
tention of  the  individual  is  concentrated  upon  his  gen- 
erative organs.  He  examines  them  man\  times  a  day, 
measures  them,  and  is  constantly  applying  lotions  and 
running  from  one  physician  to  the  other  with  stories 
of  their  deficient  power,  the  shrinkage  of  his  penis, 
the  gradual  disappearance  of  his  testicles,  etc.,  etc. 
Convinced  that  sexual  intercourse  is  altogether  beyond 
his  powers,  he  abstains  from  any  attempt,  and  contin- 
ues to  lament  his  sad  condition.  In  one  case  of  the 
kind  that  came  under  m}'  observation,  the  patient,  prob- 
ably from  some  slight  weakness  of  the  organs  due  to 
previous  excess,  contracted  the  belief,  soon  after  mar- 
riage, that  his  sexual  power  was  gone,  and  that  the  re- 
sult w^as  due  to  atrophy  of  the  testicles.     .As  a  matter 


1^4  SEXUAL    IMIM)  1EXC1-:    IX    THE    MALE- 

ot  tact,  there  was  no  change  in  the  consistence  or  ap- 
pearance of  these  organs,  but  it  was  impossible  to  con-' 
vince  him  oi  this  fact.  Under  the  idea  that  phospho- 
rus was  a  tonic  to  the  generative  system,  and  would 
cause  the  nutrition  of  the  testicles  to  be  better  effected, 
he  kept  the  scrotum  well  anointed  with  an  ointment 
containing  phosphorus,  and  drank  no  other  liquid  than 
phosphoric  acid  and  watei*.  In  this  case  the  conviction 
of  absolute  impotence  was  so  strong,  that  it  was  impos- 
sible for  an  erection  to  take  place,  even  under  the  most 
provoking  circumstances.  Indeed,  he  declared  that  all 
attempts  in  this  direction  were  a  mockery  of  Provi 
dence.  and  therefoie  in  the  highest  degree  sinful.  In 
iny  recently  published  work  on  insanit}"  '■•"  I  have 
treated  the  subject  of  hypochondriacal  mania  at  length, 
and  have  adduced  several  examples  of  the  length  to 
which  patients  will  go  in  their  false  beliefs  relative  to 
the  state  of  their  reproductive  organs.  From  that 
book  !  cite  tlie  following  instance  :  + 

"A  patient  ol  ray  own,  after  great  sexual  excesses, 
took  the  idea  that  his  penis  and  testicles  were  diminish- 
ing in  size.  He  spent-  the  greater  part  of  each  dav  in 
measuring  them  and  recording  the  results  in  a  book 
which  he  kept  for  the  purpose.  Finally  he  reached 
the  conclusion  that  they  had  entirely  disappeared,  and 
although  he  did   not  go  about    lamenting  the  fact,  he 


*  "A  Treatise  on  Insanity  and  its  Medical  Relations."     New  York, 

1803. 
•fOp.  cit.  p.  480. 


AliSEXCK    (IK    IHK    I'OWER    OK    ERECTION.  183 

was  examiniui^-  tiie  region  as  often  as  he  could  get  tlie 
opportunity,  and  making  a  record  of  the  results  of  his 
examination.  As  an  intei"esting  instance  of  the  line  of 
thought  of  a  hypochondriacal  maniac,  I  transcribe  here 
a  portion  of  his  diary  for  one  day  : 

'• '  November  4th,  9  a.m.  The  event  that  I  have  been 
fearing  has  at  length  occurred  ;  they  have  vanished  ! 
absolutely  vanished  !  and  I  am  ruined.  Oh,  my  God  ! 
how  I  am  punished  for  my  sin ! 

'"9:30.\.M.  Cold  water  does  no  good;  hot  water  is 
no  better.     Will  try  blistering. 

"  '  9:45  A.M.  Not  even  a  vestige  of  penis  or  testicles, 
not  a  vestige.  I  will  consult  a  physician.  No ;  I  can- 
not exhibit  my  misfortune.     Applied  blister. 

"  '  10  A.M.  Removed  blister  to  see  if  they  really  have 
gone.  Alas!  is  is  too  true.  Blistering  can  be  of  no 
possible  service.     Removed  it. 

"'  10:15  A.M.  Reflected  that  if  they  were  really  gone 
there  ought  to  be  something  left  to  show  where  they 
had  been.  Find  ample  evidence.  A  vast  cavity  at  the 
bottom  of  my  belly.  Will  consult  a  surgeon,  but  how 
in  heaven  can  he  help  me?  Is  there  any  medicine  that 
can  restore  the  organs  when  they  have  entirely  gone  as 
have  mine?  It  would  be  a  mockery,  a  sinful  mockery. 
God  knows  I  have  sinned  enough. 

••'10:25  A.M.  There  is  no  doubt  of  it.  They  have 
gone,  and  I  am  a  ruined  man,  I  am  no  man.  I  am  a 
eunuch,  an  unsexed  man,  a  mere  thing  without  pur- 
pose on  the  earth. 


l86  SEXUAL    IMPOTENCE   IN   THE    MALE. 

"Ml  A.^L  I  might  sing  in  the  choir  if  they  are  really 
gone.  But  oh,  God  I  for  me,  a  man,  a  strong,  lusty, 
vigorous,  boastful  man,  to  be  reduced  to  singing  in  a 
church  choir.  It  is  horrible !  But  what  else  am  1  fit 
for?  My  mind  is  certain  to  become  weaker.  I  shall 
grow  to  be  fat  and  pulpv.  1  will  be  an  oyster,  a  big. 
disgusting  oyster. 

'"ii:ioA.M.  Have  just  urinated,  and  had  the  most 
singular  experience.  The  urine  oozed  out  from  the 
place  where  the  penis  used  to  be,  but  alas  !  where  it  no 
longer  is.' '" 

This  will  suffice ;  there  were  hundreds  of  pages  of 
such  stuff.  He  finally  came  to  see  me,  and  brought 
his  diary  with  him  for  my  instruction.  He  with  the 
utmost  confidence  in  the  correctness  of  his  perceptions 
and  judgment,  attempted  to  demonstrate  to  me  the 
complete  absence  of  his  penis  and  testicles.  I  could 
detect  no  deviation  from  the  normal  standard  in  either. 
but  no  arguments  or  tests  that  1  could  applv  sufficed  to 
undeceive  him.  He  groaned  and  wept  over  his  misfor- 
tunes, walked  up  and  down  the  room  cursing  himself 
for  his  wickedness  and  the  science  of  medicine  for 
its  inability  to  help  him. 

Such  cases  are  extremely  difficult  of  cure,  the  de- 
lusions becoming  more  and  more  strongly  fixed,  and 
very  often  extending  in  other  directions.  They  con- 
stitute one  of  the  most  obstinate  forms  of  insanity  with 
which  we  have  to  deal. 

There  is.    however,   anolhcr   torni  of    hvpochondria. 


ABSENCE   OF   THE    POWER    OF   ERECTION.  1 87 

having  its  basis  in  real  or  supposed  derangements  of 
the  sexual  organs,  and  in  which  the  prognosis  is  more 
hopeful.  Cases  of  this  variety  are  founded  on  the  emo- 
tion of  remorse  for  sexual  misconduct  in  youth,  and  are 
further  characterized  by  the  displa}-  of  a  vast  amount 
of  ignorance  in  regard  to  the  anatomy  and  physiology 
of  the  reproductive  system.  The  following  extract  of 
a  letter  recently  received  from  a  young  clergyman  ex- 
hibits in  a  strong  light  most  of  the  features  of  this  form 
of  sexual  hypochondriasis  : 

"...  For  oh,  sir,  I  am  one  of  the  most  unhappy 
and  most  afflicted  of  men,  and  if  any  one  .ever  needed 
your  assistance,  I  do. 

"  In  my  youth  1  was  guilty  of  the  fearful  sin  of  mas- 
turbation, and  through  it  I  know  1  have  ruined  myself 
both  in  this  world  and  in  the  world  to  come.  All  mv 
symptoms  are  clearly  traceable  to  this  cause.     .     .     . 

"  I  will  be  as  brief  as  possible  : 

"  First.  In  the  first  place,  I  cannot  go  into  the  society 
of  ladies,  even  though  they  be  of  the  most  refined  char- 
acter (and  of  course  I  know  no  others),  without  having 
my  semen  escape.  1  do  not  have  erections,  but  it  flows 
fropi  me  involuntarily,  and  I  feel  weak  and  depressed 
mentally  and  physically  for  hours  afterwards. 

"  Second.  Then  again,  when  at  stool,  especially  when 
1  am  constipated,  and  I  am  obliged  to  strain,  the  semen 
escapes,  and  again  without  erection. 

"  Third.  I  have  repeated  nocturnal  emissions,  and 
they  are  accompanied  by  the  most  degradedlv  lascivious 


l88  SEXUAL   IMPOTENCE    IN    THE   MALE. 

dreams.  When  I  awake  I  feel  so  wretched  that  I  am 
tempted  to  commit  suicide,  rather  than  longer  endure 
my  suffering  and  contemplate  my  degradation. 

"  Fourth.  I  am  engaged  to  a  lovely  girl,  and  yet  on 
account  of  m}'  sexual  weakness  I  am  afraid  to  marry. 
I  feel  that  such  a  step  would  be  the  destruction  of  her 
and  my  happiness,  and  an  act  of  the  grossest  immor- 
ality. 

"  Fifth.  I  am  sure  that  my  condition  is  known  to 
every  one  I  meet  who  has  any  knowledge  of  such  dis- 
orders as  mine.  I  find  that  physicians  scrutinize  me 
closely,  as  if  endeavoring  to  make  a  diagnosis  from  my 
appearance,  and  that  many  others  look  at  me  sharply  in 
the  face,  as  if  suspecting  my  trouble. 

"Sixth.  1  have  pains  in  my  head  and  back;  my  di- 
gestion is  bad  ;  I  have  eructations  of  gas,  and  some- 
times of  a  sour  liquid  and  of  food  which  I  have  just 
eaten,  and  I  sleep  very  badly. 

"  Seventh.  My  penis  is  shrunken  in  size  ;  my  testicles 
are  disappearing,  both  are  softer  than  they  ought  to  be, 
and  one  hangs  a  great  deal  lower  than  the  other. 

"  Now  you  will  see  how  desperate  my  case  is.  I 
have  struggled  manfully,  I  think,  against  the  ills  that 
bear  so  heavily  upon  me,  but  without  success.  I  have 
appHed  to  physicians,  but  they  have  given  me  no  re- 
lief. One  wanted  to  burn  my  urethra  with  nitrate  of 
silver,  but  I  defer  the  operation  till  I  hear  from  you.  I 
am  willing  to  undergo  anv  suffering  to  be  cured  of  my 
affliction.  ... 


AliSKNCE    OF   THE    POWER    OF    ERECTION.  1 89 

"  As  to  my  virile  powers,  I  scarcely  dare  to  hope  that 
they  will  ever  be  restored." 

It  will  very  readily  be  seen  by  the  physician  that 
every  circumstance  on  which  this  young  gentleman  re- 
lied to  strengthen  his  conviction  that  he  was  impotent, 
was  a  purel}'  natural  phenomenon.  Doubtless,  as  he 
says,  he  had  in  his  youth  committed  masturbation. 
The  remorse  for  conduct  which  he  had  learned  was  im- 
proper, and  the  persistence  of  nocturnal  emissions,  are 
the  only  features  deserving  of  the  least  consideration  as 
causes  of  his  mental  and  physical  state.  I  required  him 
to  come  to  New  York.  On  examination  I  found  the 
generative  organs  in  good  condition.  B}-  getting  his 
thoughts  from  himself,  enlarging  his  knowledge  of  the 
anatom}-  and  physiology  of  his  sexual  system,  insisting 
on  a  full  diet,  with  plenty  of  out-door  exercise,  cold 
baths,  and  the  administration  of  the  mixture,  the  com- 
position of  which  is  given  on  page  118,  the  patient  en- 
tirely recovered  in  a  few-  weeks,  and  Was  shortl}^  after 
married.  If  there  had  been  any  real  difficulty  in  con- 
summating the  marriage,  I  think  I  would  have  heard 
of  it. 

Such  an  instance  is  a  type  of  hundreds  of  others  in 
all  parts  of  the  country.  If  the  confidence  of  the  pa- 
tient can  once  be  gained,  there  is  never  in  my  experi- 
ence any  difficulty  in  conducting  the  case  to  a  success- 
ful termination. 

Pathology  :  The  pathology  of  sexual  impotence 
arising  from  an  impossibility  of  obtaining  erections  de- 


190  Si:\l  Al      INd'O  IKNCE    IN     llll';    MALK. 

pends  upon  the  cause.  Taking  up  the  several  factors 
which  have  any  special  importance  so  far  as  the  theory 
of  their  action  is  concerned,  we  come,  in  the  first  place, 
to  the  consideration  of  the  subject  when  the  cause  is 
any  kind  of  sexual  excess. 

It  may  be  asserted  without  the  possibility  of  there 
being  any  error  in  the  declaration,  that  any  attempt  at 
the  performance  of  intercourse  or  any  manoeuvre  un- 
dertaken before  the  age  of  puberty,  is  destructive  more 
or  less  in  accordance  with  the  extent  to  which  the  ac- 
tions in  question  are  carried,  of  the  genesic  power  of 
the  individual.  Such  actions  very  generally  tend  to 
cause  early  puberty,  so  far  at  least  as  the  secretion  of 
semen  is  concerned,  and  early  puberty  of  itself  means 
an  early  loss  of  procreative  power.  This  is  only  in  ac- 
cordance with  the  general  law  of  the  organism  in  regard 
not  only  to  the  generative  function,  but  of  all  others  of 
the  system. 

Moreover,  if  a'function  is  exercised  before  the  organs 
with  which  it  is  connected  are  prepared  for  use,  by  hav- 
ing attained  to  their  development,  demands  are  made 
upon  them  to  which  thev  are  not  prepared  to  respond. 
They  are  consequentlv  overtaxed,  and  precocious  ex- 
haustion must  be  the  inevitable  result.  The  same  re- 
sult attends  the  too  early  use  of  any  organ  of  the  body. 
Take,  for  instance,  the  muscular  system,  which  in  a 
child  is  weak  and  delicate.  If  severe  physical  tasks  be 
imposed  upon  the  muscles,  they  not  onlv  break  down, 
but  the   whole    organism   of   the  child   becomes  disor- 


ABSENCE    OF   THE    POWER   OF   ERECTION.  191 

dered.  Again,  as  regards  the  brain,  which  in  early 
childhood  is  scarcely  fit  for  any  further  use,  so  far  as 
the  mind  is  concerned,  than  that  of  receiving  impres- 
sions of  surrounding  objects,  if  it  be  spurred  on  to 
the  making  of  what  to  it  are  strong  efforts  towards 
acquiring  knowledge,  it  is  not  long  before  the  evidences 
of  serious  derangement  make  their  appearance,  and  an 
era  of  suffering  begins,  which  becomes  more  and  more 
strongly  marked  with  exery  act  of  mental  exertion 
which  the  child  may  make. 

But  wath  the  sexual  apparatus  the  matter  is  worse, 
for  while  the  muscles,  the  brain,  and  the  orgfans  are 
adapted  to  some  use  from  the  ver)'  earliest  period 
of  existence,  those  intended  for  the  purposes  of  pro- 
ducing the  species  are  absolutely  incapable  of  fulfilling 
their  office  till  the  age  of  puberty  be  i-eached.  The 
effects  of  their  use,  or  rather  abuse,  for  all  use  prior  to 
that  time  is  abuse,  are  therefore  clearly  to  be  seen  from 
the  very  instant  that  they  are  subjected  to  the  maltreat- 
ment in  question. 

The  manner  in  whicli  early  excess  acts,  therefore,  is 
by  producing  premature  extinction  of  the  virile  power. 
A  function  which  ought  to  be  very  little  below  its  high- 
est point  at  fifty  years  of  age  has  come  and  gone  at 
puberty  or  soon  after.  The  nervous  centres  in  connec- 
tion wath  the  organs  are  exhausted,  the  testicles  have 
run  through  an  imperfect  process  of  development  and 
are  atrophied,  the  blood-vessels  of  the  penis  are  shrunken, 
the  erectile  tissue  of  the  organ  is  withered  and  inelastic. 


192  SEXUAL    IMPOTENCE    IN     THE    M.\T,E. 

If  all  these  changes  have  not  advanced  to  the  high- 
est point,  and  if  the  patient  be  still  young,  it  is  possi- 
ble, under  very  favorable  circumstances,  for  a  second 
development  to  take  place.  In  general  this  is  readily 
effected.  The  individual  stops  short  of  actual  ruin, 
lie  ascertains  that  the  practices  in  which  he  is  indulg- 
ing are  vicious,  both  from  a  mental  and  physical  ])oint 
of  view,  and  merely  through  the  restorative  power  of 
nature,  after  he  has  given  it  an  opportunity  to  act,  or 
through  that  factor  in  conjunction  with  proper  medical 
treatment,  his  sexual  organs  recover  their  tone,  and  ad- 
vance to  something  like  the  normal  standard  of  health. 
It  may,  however,  be  asserted  with  absolute  truth,  that 
the  boy  Avho  has  before  puberty  indulged  even  moder- 
ately in  masturbation,  will  never  be  as  strong  sexually 
as  he  would  have  been  had  he  entirely  refrained  from 
the  practice. 

But  in  not  a  few  cases  the  habits  of  the  individual 
have  become  so  firmly  established,  and  his  mental  power 
over  them  is  so  greatly  impaired,  that  he  can  make  no 
successful  effort  to  abandon  his  destructive  practice. 
The  processes  of  degradation  which  have  been  initiated 
go  on  to  such  further  points  under  the  continued  forced 
excitation,  and  drain  to  which  they  are  subjected,  that 
recuperation  is  out  of  the  question,  and  a  permanent 
state  of  impotence  is  the  result. 

In  the  adult  the  morbid  processes  which  are  set  up  in 
consequence  of  excessive  sexual  indulgences  are  b}'  no 
means  so  pronounced  as  those  which  have  just  been 


AI5SENCE    OF    T.U  K    ]'()\VKK    OF   EKFt    ||()\.  103 

described  ;  neither  are  tliey  S(i  readily  induced.  Tlic 
sexual  organs  will  stand  an  immense  amount  of  int- 
proper  usage  in  the  cases  of  some  men  ;  in  others,  hovv- 
v^ver,  their  power  of  resistance  is  much  less;  and  in  ;ill 
if  the  excess  be  continued  there  is  danger  that  a  condi- 
tion of  permanent  impotence  will  be  reached.  Tiiis 
and  all  less  pronounced  states  of  sexual  weakness  may 
be  due  to  nervous  exhaustion,  to  paralysis  of  the  erec- 
tor muscles  of  the  penis,  to  vaso  motor  disturbance 
causing  a  diminished  flow  of  blood  into  the  vessels  of 
the  organs,  especially  the  penis,  to  consecutive  atrophy 
of  the  testicles,  or  to  two  or  more  of  these  circumstances 
acting  together,  and  these  are  the  chief  physical  states 
which  are  induced  in  all  cases  of  impotence  coming  un- 
der the  present  division  of  the  subject.  They  will  bo 
more  definitely  considered  in  the  remarks  that  will  be 
made  when  the  therapeutics  proper  to  be  employed  arc 
brought  to  the  notice  of  the  physician. 

Trcatnioil. — The  treatment  of  impotence  resulting 
from  an  inability  to  have  an  erection  of  the  penis,  and 
hence  to  effect  an  entrance  into  the  vagina,  or  of  that 
less  severe  form  in  which  an  imperfect  erection  is  ob- 
tained, may  be  aj,)propriately  considered  under  the 
heads  of  Jiyi^ioiic  and  medical.  And  though  some  of  the 
agents  employed  may  very  appropriateh'  be  embraced 
imder  either  of  these  categories,  it  is  a  matter  of  no 
consequence,  so  long  as  it  is  borne  in  mind  tliat  the 
arrangement  is  one  made  only  for  purposes  of  conven- 
ience, and  not  with  a  view  to  scientific  accuracy. 


i94  SKXl'AI.    IMPOTKNCE    IX    THE    MAl.K. 

Hygienic  intasuns. —  The  tirst  and  most  important  fac- 
tor in  restoring  an  exhausted  generative  apparatus  is 
rest,  and  bv  rest  is  meant,  not  simply  a  more  moderate 
degree  of  indulgence,  but  absolute  cessation  from  all 
sexual  excitement.  Without  this  it  is  scarcely  worth 
while  for  the  physician  or  the  patient  to  expect  a  cure. 
The  period  during  which  rest  must  be  enjoined  depends 
very  mucii  on  the  degree  of  exhaustion  which  has  been 
reached.  1  have  generally  found  that  in  those  cases  in 
which  an  erection  sufficient  for  intromission  does  not 
take  place,  sexual  repose  for  about  a  year  is  necessary. 
Again,  the  age  of  the  patient  and  the  length  of  time 
during  which  the  condition  has  existed  are  factors  to 
be  considered  in  determining  the  question.  In  persons 
over  forty,  and  in  whom  the  condition  has  lasted  six 
months,  no  attempt  should  be  made  for  even  a  longer 
period  than  a  year.  With  every  unsuccessful  effort, 
even  though  no  emission  occurs,  the  nervous  excitabil- 
ity is  still  further  lessened,  and  the  itiorolc  materially 
lowered.  Generallv  in  these  extreme  cases  there  is  no 
difficultv  in  securing  the  leqnisite  quiescence.  The 
patient  is  fully  aware  of  his  inability,  and  is  in  no  mood 
to  undertake  what  he  knows  will  result  in  failure.  It 
sometimes  happens,  however,  that  masturbation,  with 
the  erection  almost  nil  and  the  orgasm  imperfect,  is 
practised,  when  the  individual  finds  that  intercourse  is 
impossible.  It  is  in  this  respect  that  the  requirement 
of  rest  must  be  strictly  enjoined. 

But  in  those  cases  in  which  the  emission  takes  place 


ABSENCE    OF   THE    POWER    OF    ERECTION.  I95 

too  soon,  and  in  which  the  erection,  though  feeble,  is 
yet  sufficient  for  intromission,  more  difficuUy  is  expe- 
rienced in  enforcing  the  prescription  of  absolute  rest. 
The  patient  may  be  profuse  in  his  promises  but  nig- 
gardly in  keeping  them,  unless  the  full  consequences 
of  his  dereliction  are  placed  before  him.  The  physician 
will  therefore  in  such  instances  be  obliged  to  speak 
very  plainly,  and  perhaps  to  present  the  alternative  of 
perfect  obedience  or  a  change  of  medical  adviser.  There 
is  nothing  to  be  gained  either  by  the  physician  or  patient, 
unless  the  condition  in  question  is  complied  with.  I 
am  thus  emphatic  on  this  point,  because  I  have  often 
found  great  difficulty  in  causing  patients  to  obey  the 
directions  given  in  regard  to  it. 

In  connection  with  this  subject  rest  of  mind  from  all 
lascivious  thoughts  is  of  almost  equal  importance.  A 
man  cannot  very  readily,  by  simple  act  of  the  will,  pre- 
vent such  thoughts  obtruding  themselves  upon  him, 
but  thei^e  is  usually  no  great  difficulty  about  the  mat- 
ter, if  he  can  be  made  to  keep  his  mind  busy  with  some- 
thing else.  Those  patients  whose  lives  are  spent  in 
idleness  are  alwa3'S  more  rebellious  in  this  respect  than 
those  who  have  some  occupation,  especially  if  it  be  one 
in  which  mental  concentration  is  required.  If  the  cir- 
cumstances of  the  patient  admit  of  it,  a  course  of  study 
is  often  a  very  efficacious  means  of  directing  the  mind 
from  sexual  matters,  and  the  beneficial  effects  of  travel 
in  unfamiliar  countries  where  there  is  much  to  engage 
the  attention  are  not  only  of  importance,  in  this  respect, 


Kjb  .SEXUAL    IMPOTENCE    IN    THE    MALE. 

but  ill  many  others  are  so  obviously  of  advantage  as  not 
to  require  furtiier  consideration. 

Bat/is. — If  the  strength  of  the  patient  is  such  as  to 
insure  a  proper  degree  of  reaction,  co/ii  baths  are  of  de- 
cided benefit.  In  such  cases  they  may  be  taken  daily 
in  the  morning,  and  may  be  either  plunge  or  sJioivcr,  as 
ma)^  be  preferred.  Sea  backs  are  especial!}-  tonic  to 
most  persons.  Warm  baths  are  sometimes  useful,  but 
in  general  they  are  better  applied  to  the  generative 
organs  either  alone  or  alternating  with  cold  water.  In 
such  cases  the  water  should  be  poured  on  the  parts 
from  a  height  of  several  feet,  either  in  the  form  of  a 
shower  or  stream,  first  the  hot,  and  then  the  cold,  a 
coarse  towel  being  then  used  for  drying  and  rubbing 
till  a  decided  sense  of  heat  is  produced.  There  are 
few  more  powerful  tonics  than  this  mode  of  using 
water. 

Douches,  either  of  hot  or  cold  water  or  of  both,  ap- 
plied to  the  skin  and  the  perineum,  are  of  decided  ad- 
vantage. As  in  the  former  method,  the  hot  and  cold 
water  may  be  used  alternately,  two  minutes  for  each 
being  an  average  period  of  application. 

TurkisJi  and  Russian  baths  are  also  of  service  taken 
about  twice  a  week,  and  not  of  long  duration  at  any  one 
time. 

The  diet  should  be  full  and  nutritious,  animal  food 
forming  a  large  proportion  of  it,  and  fat  in  some  form 
being  a  prominent  constituent.  This  latter  may  be 
taken  in  the  form  of  cream  or  of  cod-liver  or  other  oil. 


ABSENCE    Ol''    Till-:    !'<  )\\  ER    OE    ERECTION.  I97 

Glycerine  may  sometimes  be  substituted  in  the  cases  oi 
those  persons  to  whom  oil  is  disagreeable. 

Of  drinks,  tea  and  coffee  are  quite  admissible,  as  is 
also  a  glass  of  Bordeaux,  Burgundy  or  other  good  wine 
at  dinner.  The  excessive  use  of  alcoholic  liquors  is. 
however,  prejudicial  to  the  object  in  view. 

Active  bodily  exercise  is  always  of  use,  but  should  not 
be  carried  beyond  the  point  of  fatigue.  If  this  precau- 
tion is  neglected,  more  harm  than  good  will  be  done. 
Horseback  riding  is  in  general  not  to  be  advised,  unless 
in  very  great  moderation. 

In  this  connection  it  is  necessary  to  remind  the  patient 
that  he  iniist  not  s/ee/>  o)i  his  back,  and  this  especially  if 
there  are  seminal  emissions  at  night.  In  that  posture 
an  unnatural  degree  of  erethism  is  produced  in  the  sex- 
ual organs  by  the  congestion  which  it  permits  in  the 
spinal  cord  and  cerebellum,  and  which  occurring  dur- 
ing sleep,  when  the  influence  of  the  higher  parts  of  the 
brain  are  removed,  leads  to  an  automatic  activity  most 
injurious  to  the  health  of  the  organs.  Many  persons 
find  it  difficult  to  avoid  this  posture.  Usually  after  a 
time,  however,  the  individual  going  to  bed  with  the 
idea  strong  in  his  mind  that  he  is  not  to  sleep  on  his 
back,  avoids  the  position  probably  through  unconscious 
cerebration.  In  other  cases  it  is  necessary  to  resort  to 
some  device  in  order  to  correct  the  habit.  A  towel  tied 
around  the  waist  with  a  hard  knot  in  contact  with  the 
centre  of  the  back  will  generall}'  cause  the  patient  to 
awaken  when  he  gets  on  his  back,  and  the  knot  presses 


198  SEXUAL    IMI'OIENCE    IN    THE    MALE. 

Strongly  against  his  sivin.  In  other  instances  some  more 
powerful  agent  is  required.  Belts  have  been  made  of 
leather  with  sharp  tacks  driven  so  that  the  points  pro- 
jected on  the  inside,  though  covered  loosely  with  a  thjn 
cushion.  When  the  individual  rolls  over  on  his  back, 
after  having  put  the  belt  around  his  waist,  with  the 
armed  portion  pressing  lightly  against  the  body,  the 
sharp  points  of  the  tacks  penetrate  the  skin,  and 
awakening  him  cause  him  to  turn  over  on  his  side.  It 
is,  however,  rarely  the  case  that  these  contrivances  are 
necessary  for  any  considerable  period,  as  the  habit  is 
soon  acquired  of  not  sleeping  on  the  back. 

The  bed  occupied  bv  a  patient  suffering  from  noc- 
turnal emissions  should  always  be  a  hard  hair  mattress. 
I  have  repeatedly  known  emissions  during  sleep  kept 
up  in  spite  of  all  measures  employed  against  them,  solely 
by  the  fact  that  the  bed  used  was  made  of  feathers  and 
almost  overwhelmed  the  individual  when  he  got  into 
it.  Such  beds  are  too  heating :  they  do  not  allow  the 
body  to  radiate  its  natural  heat,  and  they  prevent  the 
even  transpiration  from  the  skin.  In  the  country  such 
beds  are  still  used,  though  they  are  now  rarely  seen  in 
cities. 

The  question  of  marriage  is  one  which  a  man  who  is 
threatened  with  impotence,  or  who  already  suffers 
from  it  in  consequence  of  his  excesses  in  youth  or 
adult  life,  often  submits  to  his  medical  adviser.  It 
appears  to  me  to  be  one  which  under  these  circum- 
stances, both  for  the  sake  of  the  patient  as  well  as  that 


ABSENCE   OF   THE    POWER    OF    ERECTION.  IQ9 

of  an  innocent  AA^onnan,  should  always  be  answered  m 
the  negative.  In  the  tirst  place,  from  a  sanitary  point 
of  view  marriage  cannot  lead  to  any  beneficial  result. 
It  probabh'  would  conduce  to  increased  excesses  or  at 
least  to  attempts  in  this  direction  which  could  not  faul 
to  be  of  deleterious  effect  upon  the  condition  of  the 
patient.  Moreover,  by  advising  a  man  sexuallv  im- 
potent to  contract  an  obligation  which  the  physician 
knows  he  cannot  fulfil,  an  offence  against  good  moraJs 
is  committed,  and  a  crime  against  society  perpetrated, 
for  which  there  is  no  excuse  and  which  it  is  difificult  to 
characterize  in  mild  terms.  But  I  have  known  physi- 
cians who  make  a  great  affectation  (^1  decency  and 
religion  to  deliberatelv  advise  a  broken  down  ro?/^ 
whom  thev  knew  to  be  sexually  impotent  to  wed  a 
young,  vigorous  and  pure  girl  for  the  puipose  of 
having  his  genital  svstem  stimulated  to  a  highei'  point 
than  had  yet  been  reached. 

Nevertheless  one  of  these  men  thought  it  in  the 
highest  degree  immoral  that  a  young  man  of  good 
health  who  had  never  abused  his  sexual  system,  who 
was  troubled  with  frequent  nocturnal  emissions,  and 
who  had  abstained  from  sexual  intercourse  though 
twenty-five  years  of  age,  should  have  been  told  by 
another  physician  that  the  emissions  were  an  outburst 
of  nature,  and  that  sexual  intercourse  was  indicated. 
It  is  said  that  the  first  dutv  of  a  physician  is  to  his 
patient,  and  this  is  true  so  long  as  he  performs  it  with 
a  decent  regard  for  his  obligation-  to  hinuanilv.  hut  it 


200  SEXUAL    IMPOTEXCl-:    IX    THE    MALE. 

appears  to  me  that  it  would  be  just  as  proper  foi-  him 
to  advise  an  impecunious  patient  to  replenish  his  purse 
by  picking-  some  one's  pocket  as  to  advise  his  sexually 
impotent  patient  to  contract  a  marriage  he  can  never 
consummate.  Fortunately,  however,  the  question  of 
morality  can  rarely  if  ever  arise.  It  is  injurious  to  an 
impotent  patient  to  contract  a  marriage,  for  such  a 
procedure  prevents  the  rest  to  the  debilitated  organs 
which  their  condition  so  imperatively  requires.  Noth- 
ing in  fact  can  do  more  harm. 

Medical  incaiis. — There  are  no  aphrodisiacs  or  special 
restorers  of  virility  known  to  medical  science,  notwith- 
standing all  that  has  been  said  in  regard  to  certain 
remedies.  But  while  this  is  true,  there  are  agents 
which  certainly  have  an  indirect,  in  some  cases  a 
powerful  influence  in  giving  tone  to  the  generative 
•organs  and  in  obviating  some  of  the  conditions  to 
which  the  resultant  impotence  is  due.  These  ma}'  be 
considered  in  two  categories — those  which  are  apphed 
externally  and  those  which  are  taken  into  the  system 
as  medicines. 

Externa/  remedies. — First  among  these,  and  ranking 
high  in  the  list  of  remedies,  is  electricity. 

This  agent  is  employed  under  three  forms — Galvan- 
ism, Faradism,  and  Franklinism.  In  using  galvanism 
the  only  rule  in  regard  to  the  strength  of  the  current 
is  to  bring  into  action  as  many  cells  as  will  pro- 
duce a  decided  sense  of  discomfort  to  the  patient.  The 
electrodes  should  ordinarily  consist  of  wet  sponges,  and 


ABSENCE    OF   THE    POWER    OF   ERECTION.  20I 

the  application  should  be  made  to  the  spine,  the  perin- 
eum, the  testicles  through  the  scrotum,  and  the  penis. 

In  applying  the  current  to  the  spine,  the  whole  of  the 
vertebral  column  may  be  embraced  within  the  circuit, 
though  greater  attention  should  be  given  to  the  lower 
dorsal,  the  lumbar  and  the  sacral  regions.  I  usually 
first  appl)^  one  electrode — it  makes  no  difference  which — 
to  the  nape  of  the  neck,  and  then  stroke  the  back  over 
the  spinous  processes  with  the  other  for  three  or  four 
minutes,  using  a  current  strong  enough  to  cause  a 
considerable  sensation  of  warmth  and  to  produce  red- 
ness of  the  skin.  Then  the  upper  electrode  is  placed 
over  the  middle  of  the  dorsal  region,  and  the  other 
moved  slowl}^  down  over  the  parts  below  a  dozen 
times.  The  effect  of  the  application  is  rather  unpleasant, 
than  otherwise,  and  the  back  continues  to  feel  a  sensa- 
tion of  warmth  for  an  hour  or  more  afterwards. 

Then  one  electrode  is'  placed  over  the  sacrum  and 
the  other  on  the  perineum,  and  both  are  kept  in  their 
position  for  about  a  minute.  A  current  of  somewhat 
less  strength  will  be  advisable  for  this  application,  as 
the  patient  will  not  generally  endure  one  so  strong  as 
that  used  for  the  spine. 

In  making  the  application  to  the  penis  externally,  one 
electrode  may  be  placed  on  the  perineum,  and  the  other 
on  the  glans.  the  lattei"  being  removed  exevy  five  or  ten 
seconds,  or  the  current  broken  bv  the  arrangement  for 
that  purpose  on  one  of  the  electrodes.  Two  or  three 
minutes  are  sufficient  for  this  purpose. 


202       SEXUAL  IMPOTENCK  IN  THE  MALE. 

It  is  sometimes  the  case  that  the  impotence  depends 
in  a  great  measure  on  an  anesthetic  condition  not  only 
of  the  glans  but  of  the  whole  penis.  In  such  a  case 
the  electrode  should  be  passed  over  the  whole  organ, 
and  the  strength  of  the  current  should  be  such  as  to 
cause  considerable  discomfort  if  not  actual  pain. 

In  those  cases  in  which  nocturnal  emissions  are  fre- 
quent and  the  erethism  is  so  great  that  emissions  take 
place  without  erection  or  on  slight  provocation,  it  is 
sometimes  necessarv  to  apply  the  electricitv  to  the  in- 
terior of  the  organ.  A  special  electrode  is  necessary 
for  the  purpose.  It  is  made  of  some  non-conducting 
material,  except  at  the  ver}-  extremity,  which  is  metallic 
and  is  in  connection  with  a  wire  running  through  the 
instrument  and  attached  to  one  of  the  conductors  lead 
ing  from  the  battery.  This  electrode  is  introduced 
into  the  urethra,  and  the  metallic  point  biought  into 
contact  with  the  orifices  of  the  seminal  ducts  or.  to  the 
prostatic  portion  of  the  urethra,  as  the  case  may  seem 
to  require.  As  a  remedy  for  nocturnal  emissions  or 
analogous  conditions  it  is  far  superior  to  the  cauteriza- 
tion recommended  by  Lallemand.  and  far  less  painful. 

The  application  of  galvanism  in  this  manner  is  also 
extremely  useful  in  cases  of  nervous  exhaustion,  or  in 
paralysis  of  the  erector  muscles  of  the  penis,  the  ac- 
celerator urinae,  etc.  In  this  internal  use.  the  other 
pole — the  sponge  electrode — should  be  applied  to  the 
perineum,  the  sacrum  or  the  pubis,  or  alternately  to 
each  of  these  regions,  so  as  to  send  a  current  through 


ABSENCE    OF   THE    POWER    OF   ERECTION.  203 

the  penis  in  all  directions.  The  strength  of  the  current 
need  rarely  exceed  that  from  four  or  six  Leclanche 
cells,  and  it  requires  to  be  frequently  interrupted  to 
avoid  too  great  a  degree  of  irritation. 

In  applying  galvanism  to  the  testicles,  care  must  be 
taken  to  provide  that  the  current  be  not  too  strong, 
that  from  four  or  six  cells  being  generally  amply  suffi- 
cient. Very  intense  currents  cause  a  good  deal  of  pain 
and  may  induce  syncope,  an  accident  which  has  oc- 
curred in  my  own  experience.  But  the  beneficial 
effects  of  this  use  of  the  agent  are  often  very  decided, 
even  after  the  organs  have  begun  to  become  soft  and  to 
enter  upon  a  state  of  atrophy.  The  nutrition  is  im- 
proved and  a  condition  of  greater  firmness  induced. 
With  these  changes  a  return  to  sexual  health  is  often 
initiated. 

Faradism  is  also  of  great  value  in  the  form  of  im- 
potence under  consideration.  Its  mode  of  use  is  not 
essentially  different  from  that  of  galvanism,  except  in 
certain  respects  to  be  noted. 

In  applying  the  current  to  the  spine,  one  of  the 
electrodes  should  consist  of  the  wire  brush;  the  other,  a 
wet  sponge  is  placed  high  up  on  the  neck,  and  the 
wire  brush  is  carried  down  the  spine  slowly,  the  action 
being  repeated  a  dozen  or  more  times.  The  operation  is 
a  painful  one,  but  the  reflex  stimulating  action  is  verv 
decided.  The  nutriti(^n  of  the  cord  is  imj^roved.  its 
normal  degree  of  activitv  restoied  and  the  cure  oi  the 
impotence  materiall\-  faciliatcd. 


204  SEXUAL    IMPOTENCE    IN    JIIE    MALE. 

For  the  relief  of  the  anesthetic  condition  of  the 
glans,  which  sometimes  is  a  cause  of  the  non-excitability 
of  the  penis,  one  pole,  the  wet  sponge,  is  placed  over  the 
lumbar  or  sacral  region,  while  the  other,  the  wire  brush, 
is  placed  on  the  glans.  A  mild  current  is  used  at  first, 
and  this  is  graduall}'  increased  as  the  patient  becomes 
more  used  to  it,  till  one  of  considerable  intensity  and 
causing  decided  pain  is  reached.  The  object  is  to  make 
a  marked  impression  on  the  terminal  extremities  of  the 
nerves  of  the  part,  and  this  cannot  be  done  without  ex- 
citing more  or  less  pain.  Two  or  three  minutes  are 
enough  for  this  application,  which,  however,  ought  to 
be  repeated,  sometimes  daily,  and  at  others  every 
alternate  day. 

For  application  to  the  interior  of  the  urethra  the 
faradaic  current  is  useful,  though  in  general  not  as  de- 
sirable a  means  of  employing  electricit}'  as  the  galvanic 
current.  An  electrode  of  the  same  kind  as  that 
previously  mentioned  is  introduced,  and  being  attached 
to  the  induction  machine  a  current  is  passed  as  in  the 
other  instance. 

Faradaic  currents  employed  in  the  ways  referred  to- 
should  be  frequently  interrupted.  Slowly  interrupted 
currents  are  of  little  service,  and  cause  fully  as  much 
pain  as  those  in  which  the  interruptions  are  rapid. 

Fraiikliiiic  or  Statical  Ekxtricity,  though  not  of  such 
varied  uses  as  the  forms  mentioned,  is  still  capable  o/ 
b'^ing  employed  with  great  advantage,  and  is,  in  some  re- 
spects the  preferable  kind  to  administer.     The  manner 


ABSENCE    OF   THE    POWER    OF    ERECTION.  20$ 

in  which  i  generally  employ  it  when  I  have  decided 
that  it  is  the  variety  of  electricity  most  suitable  to  the 
case  is  as  follows :  * 

The  patient  being  seated  on  the  insulated  platform, 
the  clothing  being  unremoved,  sparks  are  drawn  by 
means  of  a  large  brass  ball  from  along  the  whole 
length  of  the  spine.  The  effect  of  this  is  to  produce  a 
counter-irritant  action  and  a  degree  of  reflex  excitation 
which  no  other  form  of  electricity  so  safely  and  effectu- 
ally affords.  Each  spark  leaves  a  slight  elevation  of  the 
skin,  and  the  whole  surface  is  reddened.  The  penis 
frequently  enlarges  under  the  influence,  and  if  the 
sparks  be  drawn  from  the  sacral  region,  erections  will 
often  be  produced,  even  in  cases  in  which  they  have 
not  taken  place  for  several  months  under  the  influence 
of  venereal  excitement.  By  means  of  a  brass  electrode 
enclosed  within  a  glass  cylinder  perforated  at  one  end, 
devised  by  Dr.  W.  J.  Morton,  the  action  can  be  directed 
with  great  exactness. 

This  electrode  is  also  admirably  adapted  for  applica- 
tion to  the  perineum.  Indeed  it  would  be  difficult  to 
conduct  sparks  from  this  region  without  some  such  ap- 
pliance. 

For  the  relief  of  anaesthesia  of  the  glans  the  statical 
electricity  is  fully  as  effectual  as  galvanism,  perhaps 
even  more  so.      For  this  purpose  I  use  an  electrode, 

*  The  machine  which  I  use  is  of  four  revolving  plates  of  thirty  inches 
each,  and  three  stationary  plates,  made  for  me  by  Messrs.  J.  &  H,  Berge, 
of  this  city. 


20()  SEXUAL    IMP0TF':NCE    I.N    THE    MAEE. 

also  invented  by  Dr.  Morton,  so  arranged  that,  while 
the  sponge  extremity  is  on  the  body,  the  spark  can  be 
made  to  pass  between  two  balls  capable  of  being 
brought  close  together  or  separated  as  may  be  neces- 
sary. In  applying  it  to  the  glans  penis  the  dry  sponge 
disk  is  brought  into  close  contact  with  the  organ,  and 
the  brass  balls  being  separated  a  half  inch  or  more,  a 
powerful  effect  is  produced.  In  several  cases  I  have 
succeeded,  by  means  of  this  apparatus  and  statical  elec- 
tricity, on  restoring  sensibility  to  the  glans  and  adjacent 
tissues  when  galvanism  and  faradism  had  failed. 

On  the  whole  I  am  quite  satisfied  that  in  the  several 
forms  of  electricit}'  which  I  have  mentioned,  the  physi- 
cian has  the  most  important  of  all  means  for  the  treat- 
ment of  enfeebled  conditions  of  the  generative  system. 
There  are  other  useful  adjuncts  to  be  presently  men- 
tioned, but  they  can  none  of  them,  or  all  of  them  com- 
bined, take  the  place  of  electricity. 

A  word  more  in  regard  to  what  not  to  use.  All  belts, 
disks,  and  other  contrivances  to  be  permanently  worn 
are  worse  than  useless.  Many  of  these  affairs  furnish 
no  electricity  at  all,  being  faultily  constructed,  while 
others  onl}'^  pass  a  current  around  the  body,  no  portion 
of  which  enters  at  any  point,  and  others,  again,  though 
making  the  body  a  part  of  the  circuit,  generate  so  feeble 
and  irregular  a  current  that  it  cannot  be  of  the  slightest 
service. 

Among  other  agents  of  external  application  may  be 
mentioned  massage,  percussion,  urtication,  ?ind  flagellation. 


ABSENCE    OF    IHE    POWER    OF    ERECTION.  20/ 

I  have  no  personal  experience  with  any  one  of  them. 
The  two  latter  were  in  use  before  electricity  was 
brought  into  notice  as  a  remedy,  and  though  probably 
o{  some  service  then,  are  scarce! v  worthy  of  notice 
now.  Flagellation,  at  one  time,  was  resorted  to  as  a 
temporary  stimulus  to  an  exhausted  generative  system, 
but  I  do  not  know  that  it  is  employed  now.  It  was  ap- 
plied to  the  buttocks,  and  there  is  evidence  to  show- 
that  it  was  occasionally  otihcacious  in  causing  ei'ection 
and  even  of  reducing  the  orgasm,  but  its  influence  was 
never  anvthing  more  than  of  the  most  transient  charac- 
ter. Rousseau '-^  speaks  of  its  effects  upon  him  in  his 
childhood.  Meibomiusf  wrote  a  treatise  directed  in 
great  part  to  an  account  of  its  virtues  in  this  direction, 
and  the  Abbe  Boileau:}:  adduces  many  examples  of  its 
efficacy.  Urticatiou  w\as  flagellation  performed  with 
nettles,  and  exerted  a  similar  though  perhaps  for  the 
time  being  a  stronger  influence  than  when  ordinary 
lashes  w^ere  used. 

Mondat  §  devised  an  cxluuisiing  apparatus  into 
which  the  penis  is  put.  and  then  the  rim  being 
pressed  strongly  against  the  pubes  the  air  is  sucked 
out  by   a  pump  and  an  approach  to   a   vacuum    thus 


*  "  Confessions,"  civ.  i. 

f  "  De  flagiorum  usu  in  re  niedica  et  venerea  et  lumborum  renumque." 
London,  1765. 

\  "The  History  of  the  FlageUants,  otherwise  of  Religious  Flagellations 
among  different  Nations,  and  especially  among  Christians,"  etc.  Lon- 
don, 1783. 

§  Op.  cit.  p.  155. 


208  SEXUAL    IMl'OltNCE    IN    Till:    MALL.. 

created.  As  a  consequence  the  penis  at  once  becomes 
filled  with  blood  and  a  mechanical  erection  is  the  re- 
sult. 1  have  tried  this  arrangement  in  several  cases, 
but  have  never  known  it  to  do  any  good,  not  even  for 
the  purpose  of  obtaining  a  single  act  of  intercourse.  As 
soon  as  the  air  is  readmitted  and  the  instrument  is  re- 
moved the  blood  leaves  the  penis,  and  flaccidity  is  the 
immediate  result.  Upon  one  patient  who  employed  it 
every  application  was  attended  with  an  emission  and 
orgasm,  but  without  the  least  feeling  of  pleasure.  In 
careless  hands  it  is  very  evident  that  it  might  cause 
rupture  of  the  vessels  or  even  of  the  tissue  of  the  penis. 

Sinapisms  have  been  recommended  by  Roubaud  *  as 
being  of  decided  efficac}-  in  some  cases.  He  makes  a 
cataplasm  composed  of  linseed  meal  and  ground  mus- 
tard, used  in  varving  proportions  according  to  the 
effect  desired,  and  in  which  the  penis  is  then  enveloped. 
It  is  kept  in  this  situation  for  from  ten  minutes  to  a 
quarter  of  an  hour.     Relative  to  its  action  he  says: 

"  The  application  to  the  penis  of  a  sinapism,  even 
when  the  effect  is  lessened  by  linseed,  is  not  always  un- 
attended with  pain,  and  copulation  practised  under  the- 
excitation  it  causes  is  rather  a  punishment  than  a  pleas- 
ure. To  calm  the  pain,  which  sometimes  is  slight  and 
transitory,  1  prescribe  lotions  of  cold  water  to  the  penis, 
and  this  simple  means  permits  of  intercourse  without 
suffering. 

"  The  sinapism  is  an  energetic  means  of  treatment, 

*  Op.  cit.  p.   155. 


ABSENCE    OE    THE    I'OW  ER    OF    ERECTIOM.  2Ck) 

and  requires  prudence  and  circumspection  in  its  use. 
If  it  be  applied  blindly,  the  penis  will  be  exposed  to  in- 
flammation and  perhaps  even  gangrene  may  result,  in 
general  it  is  necessary  to  remove  the  cataplasm  as  soon 
as  the  patient  begins  to  feel  the  burning.  Almost  al- 
ways a  sufficient  effect  will  then  have  been  produced. 
A  new  application  ought  not  to  be  made  before  the 
next  dav,  or  perhaps  several  days  afterward.  The  total 
number  of  these  applications  cannot  be  predetermined. 
It  depends  upon  the  effect  obtained  and  the  state  of 
irritation  produced  in  the  penis." 

Inter nal  ycincdics.  —  \X.  would  be  very  easy  to  extend 
this  division  of  the  subject  to  a  great  limit  by  calling 
attention  to  all  the  medicines  for  impotence  which  have 
been  recommended  by  writers  on  the  subject.  There 
is  scaixely  a  remedy  of  the  materia  medica  which  has 
not  at  some  time  or  other  enjoyed  a  reputation  for  the 
cure  of  the  affection  in  question.  This  is  due  to  the 
fact  that,  as  we  have  seen,  some  forms  of  loss  of  sexual 
power  are  entirely  mental,  and  are  cured  by  whatever 
obtains  the  confidence  of  the  patient.  It  is  not  astonish- 
ing, therefore,  to  find  that  substances  with  the  most 
opposite  therapeutical  properties  have  been  found 
equallv  beneficial  in  giving  the  ability  for  sexual  inter- 
course. Bread  pills  are  fully  as  efficacious  in  these 
varieties  of  impotence  as  the  most  powerful  agent,  pro- 
vided the  patient  receives  them  with  confidence  in  their 
influence. 

But  while,  as  I  have  said,  there  are  no  special  aphro- 


2IO  SEXUAI.    TMrOlKNCK    IN     [UK    MA[.E. 

disiacs,  there  are  certainly  medicines  which  improve 
the  tone  of  the  generative  organs  by  their  influence 
upon  the  nervous  system  as  a  whole.  Among  these, 
phosphorus  is  entitled  to -a  good  deal  of  consideration. 

Probably  the  most  advantageous  manner  of  giving 
phosphorus  is  in  the  form  of  the  phosphide  of  zinc,  a 
tenth  of  a  grain  of  which  nia\-  be  administered  three 
limes  a  day  in  pill  form,  or  it  may  be  given  in  solution, 
in  oil,  or  in  a  pure  form,  as  pills  in  doses  of  the  sixtieth 
of  a  grain  three  times  a  day.  It  requires  to  be  given 
for  several  weeks  in  order  to  the  production  of  any 
permanent  effect,  though  in  a  few  cases  I  have  known 
g-reat  benefit  to  be  derived  from  its  use  after  two  or 
three  days. 

Ointments  containing  phosphorus  have  been  applied 
to  the  penis  and  scrotum,  but  they  are  of  no  more  value 
than  such  as  may  be  due  to  the  absorption  into  the 
system  of  a  minute  portion  of  phosphorus.  They  would 
be  just  as  efficacious  if  applied  to  the  head. 

The  dilute  JiypophospJiorus  aeid  is  also  an  eligible  form 
in  which  to  administer  phosphorus.  It  undergoes  very 
speedy  decomposition  in  the  stomach,  and  the  odor  is 
perceived  in  the  eructations  from  the  stomach.  The 
dose  is  from  ten  to  thirty  drops,  i))  a  sufficiency  of 
water,  three  times  a  day,  preferably  at  meal-times.  The 
taste  is  pleasant,  and  on  that  account  it  is  preferred  by 
patients  to  any  other  form  of  phosphorus. 

The  dilute  phosphoric  acid,  though  probably  not  so 
powerful  n  rcnicdv  ::s  those  just   mentioned,  is  never- 


ABSENCE   OF   THE   POWER   OF   ERECTION.  211 

theless  a  useful  medicine  in  the  treatment  of  impotence. 
It  is  doubtful,  however,  if  its  effect  is  exactly  that  of 
phosphorus,  which  is  certainly  a  tonic  and  stimulant  to 
the  whole  nervous  system.  Phosphoric  acid  is  probably 
no  more  influential  in  curing  the  affection  under  consid- 
eration than  would  be  nitric,  hydrochloric,  or  any 
other  mineral  acid.  It  is  a  general  tonic  and  nothing 
more.  The  doses,  from  ten  to  fifty  drops  properly 
diluted  with  water,  are  taken  preferably  at  meal-time 
so  as  to  mix  with  the  food.  It  makes  a  pleasant 
drink. 

Ntix  vomica  and  one  of  its  active  principles,  strychnia, 
are  also  medicines  of  great  value  in  the  treatment  of 
impotence  coming  from  excess.  The  former  may  be 
given  in  doses  of  the  third  of  a  grain  of  the  extract  in 
pills,  or  preferably  combined  with  the  phosphide  of 
zinc.  A  pill  which  1  use  largely  in  the  affection  in 
question  is  thus  composed  : 

IJ  Zinci  phosphidi gr.  x. 

Nucis  vomicae  exi gr.  xxxiii. 

M.  ft.  in  pill  No.  C. 

Dose,  one  three  times  a  day  after  meals. 

There  are  few,  if  any,  internal  remedies  so  generally- 
efficacious  in  the  alleviation  or  cure  of  impotence  aris- 
ing from  sexual  excesses  as  this  combination. 

Strychnia  may  be  given  in  pill  or  in  solution,  in  water, 
in  doses  varying  from  the  sixty-fourth  to  the  twenty- 
fourth  of  a  grain,  or  more,  of  the  sulphate,  three  times 
a  da}^     It  is  preferably  given  in  gradually  increasing 


212  SEXUAL    IMPOTENCE   IN   THE   MALE. 

doses,  Starting  with  the  quantity  first  named  and  carry 
ing  them  slowly  up  to  the  last  designated  amount. 

Instead  of  using  water  as  a  solvent  it  is  much  better 
to  employ  either  the  dilute  hypophosphorus  acid  or 
the  dilute  phosphoric  acid.  The  combination  of  the 
former  which  I  am  in  the  habit  of  prescribing  is  as 
follows : 

i^   Strychnire  sulphatis gr.  iii. 

Acidi  hypohosphori  diluti oz.  iv. 

M.  ft.  sol.  Dose,  ten  drops  in  water  three  times  a  day,  the  doses  to  be 
increased  a  drop  every  day  up  to  twenty-five  drops. 

In  this  way  a  regular  increase  of  the  dose  is  effected 
until,  at  the  end  of  fifteen  days,  the  patient  is  taking 
twenty-five  drops,  a  little  more  than  the  twenty-fifth  of 
a  grain  three  times  daily.  The  dose  may  then  be  kept 
at  this  point  for  ten  days,  and  then  again  increased  up 
to  forty  or  even  fifty. drops.  If  the  patient  is  then 
markedly  better,  the  further  administration  should  be 
stopped  for  a  fortnight,  and  then  the  medicine  may  be 
resumed  in  doses  of  ten  drops  three  times  a  day,  as 
before,  with  a  slight  increase.  So  long  as  benefit  is  de- 
rived this  course  may  be  continued.  I  have  persevered 
in  this  wa}^  with  it  for  over  a  year  with  the  most  happy 
results. 

If  after  carrying  the  closes  up  to  fifty  drops  there  is  no 
alleviation  whatever,  it  is  scarcely  worth  while  to  repeat 
the  procedure. 

The  phosphoric  acid  may  be  given  in  like  manner, 
and  in  those  cases  which  are  occasionally  met  with  in 


ABSENCE    OF   TIIK    rOWEU    OF    ERFCTION.  213 

which  the  hypophosphorus  acid  is  not  well  borne  by 
the  stomach  it  is  to  be  preferred.  In  the  use  of  both 
medicines  the  quantity  of  water  used  as  a  diluent  should 
be  increased  as  the  dose  is  augmented,  until,  when 
forty  or  fifty  drops  are  given,  the  amount  should  be  a 
tumblerful.  In  some  cases  in  which  the  sj^stem  is 
greatly  reduced  iron  is  of  benefit,  and  it  may  be  added 
to  the  mixture  first  given  in  the  form  of  phosphate,  or 
it  may  be  given  separately  in  any  other  combination  of 
a  tonic  character,  or  singlv. 

Cod-livc7-  oil  is,  I  think,  a  ver}'  valuable  adjunct,  and  I 
rarely  treat  a  case  of  impotence  of  the  kind  under  notice 
without  giving"  it  in  some  form  or  other :  an  emulsion 
with  the  hypophosphites  is  a  very  eligible  preparation. 

With  the  exception  of  one  agent  of  reputed  aphro- 
disiac properties  there  are  no  others  of  any  special 
value  in  the  treatment  of  impotence.  Derangements  of 
other  organs,  however,  require  to  be  met,  such  as  dys- 
pepsia, when  pepsin  may  be  given  ;  diarrhoea,  which  is 
to  be  treated  as  in  ordinary  cases,  and  so  on  with  other 
non-essential  conditions.  The  substance  to  which  ref- 
erence is  made  is  cantharidcs,  and  a  few  words  in  regard 
to  it  are  necessary,  if  onlv  to  point  out  the  dangers  at- 
tendant on  its  administration. 

Cantharides  act  on  the  generative  system  as  a  violent 
irritant,  but  this  effect  is  altogether  secondary  to  its  in- 
fluence in  causing  inflammation  of  the  bladder.  In  large 
doses  the)'  produce  this  effect  very  speedily,  and,  with 
it,  often  cause  a  state  of  satyriasis  characterized  by  in- 


214  SKXUAI.   nirOTENCE   IN    THE    MALE. 

tense,  long-continued  prini^isni  with  irresistible  impulses 
to  sexual  intercourse  or  masturbation,  which  frequent 
repetition  does  not  mitigate.  Many  instances  of  their 
poisonous  effects  are  cited  bv  authors,  and  not  a  few 
deaths  have  been  the  consequence  of  their  improper 
administration. 

But  occasionally  in  some  cases  of  impotence  of  recent 
occurrence  benefit  mav  be  derived  from  the  cautious 
administration  of  cantharides.  The  only  admissible 
form  is  the  tincture,  and  this  I  usually  give  in  doses  of 
fifteen  drops  three  times  a  day,  increasing  the  doses  a 
drop  for  those  of  each  dav  till  'ilip-ht  strangury  is  pro- 
duced. If  there  is  going  to  be  any  beneficial  effect  it 
will  be  experienced  at  or  about  this  time;  if  not,  it  is 
scarcely  worth  while  to  peisevere  with  the  remedy  in 
this  manner. 

For  the  impotence  which  results  from  disease  exist- 
ing in  the  brain  or  spinal  cord  no  special  treatment  is 
iiecessary  or  proper,  as  the  therapeutical  measures 
should  be  directed  against  the  affection  of  which  the 
impotence  is  onh'-  a  secondary  condition.  To  do  other- 
wise would  often  be  extremely  prejudicial  to  the  pa- 
tient affected  with  organic  disease.  For  instance,  loss 
of  sexual  power  is  often  a  state  present  in  locomotor 
ataxia.  Phosphorus  and  strychnia  are  contraindicated 
in  locomotor  ataxia,  and  if  administered  will  quite  cer- 
tainly increase  the  spinal  trouble  and  at  the  same  time 
render  the  impotence  more  profound. 

And  in  general  in  all  cases  of  symptomatic  impotence 


ABSENCE    OF   TME    I'OWFR    f)l     ICKF.CTION.  21 S 

of  the  form  under  notice  the  treatment  is  to  be  directed 
against  the  original  disease  which  is  the  cause.  When 
that  is  remedied  the  sexual  weakness  will  probably  also 
disappear,  but  if  not,  then  the  remedial  measures  men- 
tioned can  be  brought  to  bear  against  it. 

1  have  said  nothing  of  cauterization  of  the  urethra 
after  the  manner  recommended  by  Lallemand  and  fol- 
lowed by  very  many  surgeons  of  the  present  time,  for 
the  reason  that  I  think  it  is  a  most  pernicious  practice, 
and  one  that  can  scarcelv  ever  fail  to  do  harm  with- 
out doing  any  good  commensurate  with  the  pain  and 
danger  attendant  on  its  employment.  Theie  is  nothing 
that  can  be  done  by  cauterization  that  cannot  be  better 
and  more  safely  effected  b}-  electricity  in  any  of  the 
ways  mentioned.  1  have  cauteri-zed  manv  patients  in 
my  time,  before  I  knew  better,  and  1  have  caused  a 
great  deal  of  suffering  thereby  and  conferred  a  very 
small  modicum  of  good,  and  I  therefore  cauterize  no 
longer.  I  have  seen  violent  inflammation  of  the  ure- 
thra, stricture,  orchitis,  epididymitis,  and  cystitis  pro- 
duced by  it.  Some  of  these  accidents  have  occurred  in 
my  own  practice,  and  others  in  the  experience  of  other 
surgeons.  To  be  sure,  in  the  great  majority  of  cases  the 
operation  does  nothing  more  than  cause  a  great  deal  of 
pain  and  a  more  or  less  severe  inflammation  of  the 
urethra,  but  these  events  are  quite  unnecessary,  as  they 
never  follow  the  proper  use  of  electricity,  and  the  latter 
is  far  more  beneficial  than  is  cauterization  in  giving  tone 
to  the  pari?  and  arresting  in voluntarv  seminal  discharges. 


2i6  SEXLAL    l.Ml'OTl'NeK    IN    TilK    MALE. 


CHAPTER   III. 

ABSENCE   OF   THE   POWER   OF   EJACULATING   THE 
SEMINAL   FLUID    INTO   THE   VAGINA. 

Impotence,  from  the  cause  to  be  considered  in  the 
present  chapter,  iua\  be  due  to  malformation,  disease, 
or  some  other  anomaly  of  the  penis,  to  like  conditions 
of  the  testicles  or  their  annexge,  or  to  some  condition 
existing  m  the  body  as  a  whole,  preventing  the  emis- 
sion of  the  seminal  fluid  into  the  vagina. 

The  Penis. — Absciu-e  of  the  penis.  The  penis  may  be 
absent  from  birth.  Cases  of  the  kind  have  been  cited  by 
authors,  and  among  them  is  one  referred  fob}-  Fodere.* 
The  case  was  that  of  a  young  soldier,  full  of  courage 
and  strencrth.  who  had  well-formed  testicles,  but  where 
the  penis  Ought  to  have  been,  had  only  a  button  Hke 
the  nipple  of  the  mammary  gland,  in  which  the  urethra 
terminated.  He  declared  that  he  was  born  so.  and 
that  sometimes,  in  presence  of  young  persons  of  the 
other  sex,  the  button  swelled,  and  that  by  friction,  a 
thin  white  liquid  was  expelled. 

N^laton  reports  the  case  of  an  infant  brought  to  him 
for  examination  by  a  midwife.  The  child  was  two  days 
old,  and  was  perfectly  well  formed  and  healthy,  except 

*"Traite  de  medecine  legal  et  d'hygiene  publique."     Paris,  1013,  t.  i 

r-  364- 


NON-KJACUI.ATIOS'    OF    IHE    bEMINAl,    FLUID.       21/ 

that  there  was  an  entire  absence  of  the  penis.  There 
were  no  traces  ot  that  organ,  no  cicatrix,  nothing.  The 
scrotum  was  well  formed,  and  the  testicles  were  in  the 
proper  places.  The  urine  escaped  by  the  rectum. 
There  was,  in  fact,  a  kind  of  cloaca,  such  as  is  met  with 
in  birds  and  some  other  animals. 

In  such  cases  impotence  is  the  inherent  condition  of 
the  organism.  In  the  other  cases  it  may  be  acquired, 
though  just  as  absolute,  from  the  auipittation  or  destruction 
of  the  penis,  but  in  such  cases  the  organ  must  have  been* 
removed  to  a  very  considerable  p|irt  of  its  extent.  How 
much  this  must  necessaril}^  be  in  order  to  prevent  en- 
trance and  ejaculation  into  the  vagina,  it  is  difficult  to 
determine  ci  priori.  I  know  of  a  case  in  which  the 
organ  was  wounded  by  the  accidental  discharge  of  a 
pistol  carried  in  the  trousers  pocket,  and  in  which  a 
surgical  operation  removed  all  of  it  but  about  one  inch  ; 
but  th.e  man  in  whom  this  occurred  assured  me  that  he 
was  able  to  discharge  semen  into  the  vagina ;  at  any 
rate,  he  got  married  after  his  mutilation,  and  within  a 
year  thereafter  his  wife  had  a  child.  There  was  never 
any  complaint  from  either  party  in  regard  to  the  man- 
ner in  which  the  conjugal  duties  were  performed. 

Less  than  an  inch,  I  think,  would  not  be  sufficient  to 
effect  entrance  and  emission  into  the  vagina,  though  it 
might  be  enough  to  give  the  sexual  orgasm  and  pleas- 
urable sensations. 

During  the  recent  war,  and  since  its  close,  several 
cases  of  partial  destruction  of  the  penis  from  gunshot 


2l8  SEXUAL    niPOTENCE    IX   THE    MALE. 

injury  have  come  under  rav  notice,  but  in  all  these 
enough  of  the  organ  remained  to  serve  the  purposes  of 
sexual  intercourse. 

In  surgical  operations  requiring  the  amputation  of 
the  penis  as  much  of  the  organ  should  be  left  as  pos- 
sible. I  have  oiilv  removed  it  twice,  and  in  both  these 
instances  not  more  than  half  an  inch  could  be  spared 
to  the  patient.  I  never  heard  oi  the  result  so  far  as 
intercourse  or  the  orgasm  was  concerned. 
,  SiNnllntSs  of  the  /■mis  as  a  cause  of  impotence  cannot 
be  very  effective.  Foderc  "  is  scarcely  inclined  to 
admit  it  as  a  factor.  Occasionally,  however,  it  exists, 
and  Roubaud  f  gives  the  following  case  as  in  point  : 

"  A  student  of  medicine,  nineteen  or  twenty  years  of 
age,  and  a  Brazilian  by  birth,  came  to  consult  me.  He 
was  thin,  his  voice  feminine,  the  muscular  system 
scarcely  developed.  His  face  and  chest  were  devoid 
of  hair,  and  there  was  very  little  on  the  pubcs.  Be- 
fore showing  me  his  organ  the  patient  mformed  me 
that  he  not  only  had  desire,  but  also  frequent  erections, 
and  that  when  he  masturbated,  the  emission  took  place 
with  all  the  ordinary  voluptuous  sensation,  but  that 
when  he  had  intercourse,  no  matter  how  great  an  effort 
he  might  make,  ejaculation  never  occurred.  The  case 
was  singular,  and  before  losing  myself  with  hypotheses 
relative  to  a  nervous  sur-excitation  which  might  have 
placed  an  obstacle  to  the  free  circulation  of  the  semen, 

*  Op.  rit.  p.  366.  I  Op.  cit.  p.  93. 


NON-EJACULA'llON    OF   THE   SEMINAL   FLUID.      219 

I  asked  to  see  the  organs  of  generatioiL  What  was  mv 
astonishment  to  find  a  penis  almost  imperceptible,  of 
which  it  was  difficult  to  discover  the  glans.  The  scro- 
tum, the  testicles,  the  vasa  deferentia,  all  the  apparatus 
were  equally  liliputian.  The  penis  when  in  a  state  of 
erection  was  of  about  the  circumference  of  the  quill  of 
a  porcupine,  and  about  two  inches  in  length.  The 
testicles  were  hardly  of  the  size  of  a  filbert,  and  were 
difficult  to  find  when  the  scrotum,  becoming  relaxed, 
left  them  without  its  support." 

A  case  in  which  the  penis  was  no  longer  than  that 
described  was  some  years  since  under  my  observation. 
It  was  of  about  the  circumference  of  an  ordinary  lead 
pencil,  and  about  two  inches  in  length.  It  was  well 
formed  in  other  respects  and  copulation  was  performed 
not  very  satisfactorily,  I  was  led  to  believe,  but  yet  not 
altogether  without  pleasure. 

Great  size  of  t/ie  penis.  This  can  hardly  be  a  cause  of 
impotence  except  in  regard  to  some  women.  As 
Fodere  ^  says,  the  extreme  dimensions  of  the  penis  may 
cause  the  sexual  act  to  be  painful  to  both  parties,  and 
may  give  raise  to  contusions  and  abrasions.  Zacchias 
cites  the  case  of  a  Roman  courtezan  who  always  had 
an  attack  of  syncope  when  she  had  sexual  relations  with 
one  of  her  lovers  who  possessed  a  very  large  penis. 
Neither  extreme  smallness  of  the  penis,  nor  its  great 
size,  are  capable  of  being  alleviated  by  remedial  mea- 

*  Op.  cit.  p.  365. 


220  SEXUAL    I.M  I'OTEXCE    IN    THE    MALE. 

sures.  The  apparatus  of  Mondat  previously  mentioned 
has  been  recommei«ded  for  the  former  condition,  but  it 
is  quite  useless  for  such  a  purpose,  or  indeed  for  any 
other. 

Bifurcation  of  the  penis,  either  of  itself  or  with  its 
ordinary  accompaniment,  extrophy  of  the  bladder,  may 
be  a  cause  of  relative  impotence,  but  scarcely-  of  the 
absolute  loss  of  the  power  of  ejaculating  the  semen  into 
the  vagina.  Gore  (^de  Boulogne)  communicated  in 
1844  to  the  Academy  of  Sciences  the  case  of  a  double 
penis,  of  which  the  two  corpora  cavernosa  were  per- 
fectlv  separated  and  provided  each  with  a  urethral 
canal,  and  Isidore  Geoffroy  Saint  Hilaire  reported 
the  case  of  an  adult  in  whom  the  two  organs  were 
separate  and  placed  one  above  the  other.  In  this 
instance  the  urine  and  semen  flowed  through  both 
penises. 

Suture  of  the  penis.  By  this  term  is  understood  a  con- 
dition in  which  the  under  surface  of  the  penis  does  not 
exist ;  being  merged  in  the  scrotum,  a  single  cutaneous 
envelop  therefore  encloses  both  the  penis  and  testicle? 
so  that  the  organ  is  incapable  of  erection. 

In  a  case  of  the  kind  which  came  under  the  care  of 
J.  L.  Petit,  an  operation  was  performed  by  which  the 
penis  was  separated  from  its  attachment,  but  it  still  con- 
tinued to  preserve  its  abnormal  curve.  Bouisson  oper- 
ated in  a  similar  case,  and  with  better  success,  for  the 


*Comptes  rendus  de  I'Academie  des  Sciences.     June  i,  1844. 
f  Ibid.,  1S44. 


NOX-KJACULAllON    OF    THE    SEMINAL    FLUID.       221 

individual  was  able  to  eject  the  urine  to  some  distance 
and  even  to  have  emissions  with  erections. 

Anomalies  of  the  iirctlira  may  lead  to  impotence  of 
the  kind  under  consideration.  Hypospadias,  in  which 
the  orifice  of  the  urethra  is  on  the  under  surface  of  the 
penis,  is  one  of  these,  provided  the  opening  is  so  far  back 
as  to  cause  the  semen  to  be  ejaculated  externally  to  the 
vagina.  In  some  of  these  cases  a  surgical  operation 
may  be  effective  in  closing  the  original  opening,  and 
making  one  far  enongh  in  front  to  allow  of  emission 
into  the  vagina  during  sexual  intercourse. 

In  epispadias  the  opening  is  also  farther  towards  the 
proximal  extremity  of  the  penis  than  is  normal,  but  it 
is  on  the  superior  surface.  Here,  again,  if  the  opening 
is  sufficiently  far  back  the  emission  during  intercourse 
will  take  place  outside  of  the  vagina.  In  other  cases 
in  which  it  is  nearer  the  distal  extremity  emission  into 
the  vagina  is  possible. 

Besides  these  vices  of  conformation  the  penis  is  sub- 
ject to  certain  diseases  which  interfere  more  or  less 
effectually  with  the  ejaculation  of  semen  into  the 
vagina.  Strictures  of  the  urethra  are  among  the  chief 
of  these. 

In  stricture  of  the  urethra  the  calibre  of  the  canal 
may  be  so  greatly  reduced  as  to  prevent  the  passage  of 
the  semen  from  the  penis.  It  is  obstructed  by  the  nar- 
rowed portion  of  the  urethra  and  flows  backward  into 
the  bladder.  Besides  this  there  is  no  doubt  that  stric- 
tures of  the  urethra  can,  when  not  so  great  as  to  pre- 


222  SKXUAI.    IMl'OTKXCK    IN    THE    MALE. 

vent  the  passage  of  the  semen,  interfere  very  materially 
with  the  capacity  for  erection,  and  hence  they  become 
another  cause  of  impotence.  Civiale  pointed  out  this 
fact  when  he  said  : 

"  Among  the  other  local  effects  of  strictures  of  the 
urethra  which  are  worthy  of  the  attention  of  the  practi- 
tioner, since  they  furnish  valuable  indications  for  the  es- 
tablishment of  a  diagnosis  and  for  appreciating  the  prog- 
ress of  the  disease,  are  those  which  relate  to  the  function 
of  generation.  Erections  do  not  take  place  as  they  do  or- 
dinarily in  healthy  men,  cither  because  the  penis  cannot, 
owing  to  the  rigidity  of  the  canal,  assume  the  proper 
position,  or  because  the  blood  does  not  come  in  suffi- 
cient quantity  to  the  corpora  spongiosa  and  corpora 
cavernosa."  - 

Several  cases,  partly  confirmatory  of  these  remarks  of 
the  great  French  surgeon,  have  come  under  my  obser- 
vation, in  which  not  only  the  power  but  the  desire  was 
also  extinguished  ;  but  I  am  inclined  to  think  that  these 
results  w^ere  to  be  attributed  altogether  to  the  moral 
associations  of  the  condition.  A  patient,  for  instance, 
has  a  stricture,  and,  as  is  often  the  case,  in  diseases  of  the 
kind,  allows  his  mind  to  dwell  on  the  subject,  till  a  state 
of  hypochondriasis  is  induced.  No  phase  of  mental 
derangement  is  more  calculated  to  abolish  sexual  de- 
sire than  this,  lor  not  only  is  there  a  condition  of  aber- 

*  "  Traite    pratique  sur   les    maladies    des    organes   genito-urinaires," 
Paris,  p.  143. 


NON-EJACULATION    OF    THE    SEMINAL    ELl'lD.       223 

ration,  but  the  mind  is  constantl}'  preoccupied  with  a 
single  engrossing  subject  to  the  exclusion  of  all  other 
topics  and  even  of  so  absorbing  a  one  as  the  sexual  feel- 
ing. Besides,  there  are  some  men,  and  it  would  be  well 
if  there  were  more  of  them,  who  think  it  dishonest  while 
suffering  from  any  disease  of  the  generative  organs  to 
have  intercourse,  and  if  under  peculiar  circumstances 
they  are  carried  away  for  the  moment  by  the  height 
of  their  passion  the  power  is  apt  to  fail  at  the  very  mo- 
ment when  it  is  required.  The  piinciple  to  which  al- 
lusion has  already  been  made  is  also  influential.  The 
individual  with  a  stricture  is  often  doubtful  in  reg-ard 
to  his  abilitv  to  accomplish  the  sexual  act  in  a  satisfac- 
tory  manner.     To  doubt  is  to  fail. 

But  I  have  been  consulted  in  cases  in  wmch  t'  "  waq 
no  such  mental  trouble  and  in  which  the  onl)-  function 
lacking  to  the  act  of  intercourse  was  the  non-ejaculation 
of  the  seminal  fluid  into  the  vagina.  It  maybe  said 
that  such  cases  come  under  the  head  of  sterility,  an  asser- 
tion which  would  be  verv  true  so  far  as  the  practical 
results  are  concerned,  but  as  the  act  of  sexual  inter- 
course consists  in  the  essential  features,  intromission,  a 
pleasurable  orgasm  and  ejaculation  of  semen  into  the 
vagina,  it  follows  that  one  of  the  elements  of  the  per- 
fectibilit}'  is  wanting.  Besides,  the  non-ejaculation  of 
semen  interferes,  there  is  reason  to  believe,  with  the 
voluptuous  sensations  experienced  by  both  parties. 

Impotence  depending  on  this  cause  is  to  be  treated 
by  the  surgical  means  proper  in  the  management  of  ure- 


224       SEXUAL  IMPOTEN'CE  IN  THE  MALE. 

thral  stricture,  by  dilatation,  electrolysis,  or  incision, 
as  the  case  may  appear  to  require.  With  the  relief  of 
the  condition,  the  sexual  act  can  of  course  be  performed 
in  its  entirety. 

Spasmodic  Stricture. — Although  there  probably  is  no 
such  thing  as  a  permanent  spasmodic  stricture  of  the 
urethra  I  am  quite  sure  that  there  is  such  an  affection, 
lasting  from  a  few  minutes  to  an  hour  or  more,  and 
which,  while  it  lasts,  effectually  prevents  the  emission  of 
semen  or  the  passage  of  the  urine.  In  speaking  of  this 
subject  MM.  Grimaud  de  Caux  and  Martin  Saint- Ange 
say : 

"  Finally  we  must  admit  the  existence  of  another  form' 
of  stricture  of  the  urethra :  it  is  that  which  is  caused  by 
-1  nervous  SLc^.e  ot  the  canal  which  becomes  so  mucli 
contracted  as  to  entirely  obliterate  its  calibre,  the  sides 
being  brought  in  contact  with  each  other.  Such  an  ob- 
stacle to  the  passage  of  the  urine'  is  never  more  than 
temporary,  lasting  at  most  only  an  hour  or  two,  although 
b}^  its  frequent  repetition  causing  much  suffering  to 
those  who  are  its  subjects.  It  was  an  affection  of  the 
kind  in  question  which  rendered  J.  J.  Rousseau  so  im- 
happy,  and  so  unsupportable  to  himself  and  others. 
He  was  supposed  to  suffer  from  stone  in  the  bladder. 
Morand,  however,  could  never  detect  such  a  body 
by  sounding,  so  Rousseau  had  recourse  to  '  Frere 
Come,'  who,  having  penetrated,  though  with  difficulty, 
to  the  bladder,  found  it  to  be  free  from  a  calculus.  This 
examination  rendered  him  for  the  time  a  little  more  quiet, 


NON-EJACULATION    <>F    'IHE    SEMINAL    ILUID.      225. 

but  the  spasms  of  the  urethra  having  reappeared,  hypo- 
rhondria  supervened  to  darken  the  mental  horizon  v^ 
the  philosopher  and  to  disgust  him,  as  every  one  knows, 
w^ith  all  the  objects  of  his  love  and  friendship.  If  the 
author  of  "  Emile  "  had  lived  in  our  day,  under  the  in- 
fluence of  the  progress  of  science  in  the  treatment  of 
diseases  of  the  urinary  passages,  it  is  more  than  probable 
that  the  greater  part  of  his  life,  especially  its  end,  would 
have  felt  the  full  power  of  his  character  and  genius, 
which  being  of  late  development  would  haveilkiminated 
his  existence  in  his  old  age." 

I  have  seen  several  cases  in  the  course  of  my  experi- 
ence in  which  the  condition  of  the  author  of  the  "Con- 
fessions" was  almost  exactly  repeated,  leading  to  great 
unhappiness,  both  as  regarded  its  effect  vipon  the  mar- 
riage relation  and  the  mind  generally.  The  description 
of  one  or  two  of  these  instances  will  tend  more  dis- 
tinctly to  the  elucidation  of  the  main  points  of  the  affec- 
tion than  any  merely  didactic  account. 

A  Pfentleman  who  had  never  been  addicted  to  women 
before  marriage  but  who  since  that  event  had  been  ex- 
cessive in  marital  indulgence  had  suffered  for  many 
years  with  a  degree  of  nervous  irritabihty  which  put 
him  out  of  humour  with  himself  and  all  the  rest  of, 
humanity  with  which  he  had  anything  to  do.  He  was 
apt  to  be  attacked  periodically  with  neuralgia  of  the 
fifth  pair  of  nerves,  sometimes  on  one  side  and  again  on 
the  other,  and  at  these  periods  he  was  particularly  liable 
to  the  occurrence  of  morbid   feelings,  which  affected 


226  SEXUAL    IMPOTENCE    IX    THE    MALE. 

him  acutely  and  which  plunged  him  into  the  lowest 
depths  of  despair.  Frequently  at  such  times  he  had 
thought  seriously  of  suicide,  and  upon  one  occasion  had 
made  elaborate  preparations  for  its  perpetration.  For- 
tunately the  paroxysm  disappeared  as  suddenly  as  it  had 
supervened,  and  his  thoughts  underwent  an  immediate 
change.  At  these  periods  there  was  often  an  incongru- 
ous desire  for  se.vual  intercourse  and  of  the  most  irresis- 
tible character,  and,  strange  to  say,  he  never  had  desire 
at  other  times.  But  though  he  made  frequent  attempts 
at  sexual  intercourse,  and  though  there  were  strong- 
erection  and  orgasm  attended  with  a  certain  amount  of 
pleasure,  there  was  no  emission ;  but  the  convulsive 
movements  of  the  muscles  concerned  were  almost  im- 
mediately followed  by  a  sharp  pain  deep  in  the  urethra, 
and  which  extended  apparently  to  the  rectum,  though  in 
this  situation  being  a  dull  dragging  sensation,  as  though 
the  organ  were  greatly  distended.  This  did  not  hap- 
pen once  onlv,  but  every  time  that  ht-  had  connection 
the  like  series  of  phenomena  took  place,  and  as  he  could 
not  explain  the  circumstance  it  caused  him  a  great  deal 
of  additional  distress.  He  would  have  abstained  from 
intercourse,  but  his  sexual  appetite  at  these  times  was 
■very  active,  and  although  he  controlled  it  to  a  great  ex- 
tent, he  could  not  altogether  obtain  the  mastery  of  his 
desire.  He  was  rapidlv  getting  to  be  hypochondriacal 
on  the  subject,  as  the  belief  was  being  entertained  that  he 
was  becoming  sterile  owing  to  a  non-secretion  of  semen. 
He  was  very  much  averse  to  attempting  sexual  inter 


NON-EJACULATION    OF   11  i  K    SEMINAL    FLUID.      22; 

course  at  other  times  than  when  his  j)arc)xysins  of 
mental  depression  and  neuralgia  attacked  him,  as  he  had 
no  desire  during  these  intervals ;  in  fact,  the  idea  was 
extremely  repugnant  to  him.  But  at  ni}'  earnest  sug- 
gestion he  consented  to  make  an  effort  in  that  direction, 
and  the  result  was  his  entire  satisfaction,  that  he  was  in 
every  respect  capable  of  the  physiological  performance 
of  the  act  of  sexual  intercourse. 

Repeated  examinations  with  sounds  had  previously 
convinced  me  that  there  was  no  organic  obstruction  of 
the  urethra,  and  the  fact  I  hat  there  had  never  been  anv 
difficulty  in  voiding  urine  was  of  itself  sufficient  evidence 
on  this  point;  but  to  make  it  absolutely  certain  that 
there  was  an  ejaculation  of  semen,  which,  however, 
failed  to  reach  the  meatus.  I  desired  him  to  brine-  me 
the  urine  which  he  passed  immediately  after  the  act  of 
intercourse  while  under  the  influence  of  one  of  his 
attacks.  This  he  did,  and  on  examining  the  sediment 
with  the  microscope  it  was  foimd  to  consist  almost  en- 
tirely of  semen,  with  the  normal  proportion  of  sperma- 
tozoa, dead,  however,  from  the  influence  of  the  urine. 
It  was  very  certain  therefore  that  my  patient  ^vas  suf- 
fering from  a  spasmodic  contraction,  of  the  urethra 
which  closed  the  canal  and  caused  the  seminal  fluid  to 
be  thrown  back  into  the  bladder. 

I  treated  this  patient  by  galvanism.  A  urethral  elec- 
trode was  passed  down  to  the  veru  montanum  every 
day  while  he  was  exposed  to  the  affection,  and  a  current 
from  ten  of  Hill's  gravity  cells  was  })assed  through  it  to 


228  SEXUAL   IMPOTENCE    IN    THE    MALE. 

another  electrode  introduced  into  the  rectum.  This  was 
done  for  about  five  minutes  at  each  seance.  At  the  same 
time  and  during  the  intervals  of  health  the  bromide  oi 
sodium  was  administered  in  doses  of  fifteen  grains  a  day. 

I  began  this  treatment  at  the  very  beginning  of  one 
of  his  paroxysms,  and  continued  the  galvanism  for  the 
ten  days  that  it  lasted.  During  this  period  there  was 
no  improvement,  but  during  the  whole  of  the  next 
paroxysm,  intercourse  was  performed  in  a  perfectly 
satisfactory,  manner,  and  moreover  there  was  a  notable 
diminution  in  his  desire,  which  had  become  more  like 
that  of  a  man  in  a  normal  condition. 

In  the  other  case  the  patient,  a  young  man  twenty- 
five  years  of  age,  had  been  guilty  of  gross  excesses, 
though  thus  far  there  had  been  no  notable  diminution 
of  sexual  power.  One  night,  however,  while  in  the  act 
of  sexual  intercourse,  he  was  surprised  by  an  intense 
pain  in  the  rectum,  and  by  the  non-emission  of  semen. 
The  pain  was  of  such  an  agonizing  character  that  he  al- 
most fainted.  It  lasted,  however,  only  for  a  few  seconds, 
but  it  was  more  than  an  hour  before  he  had  entirely  re- 
covered from  the  nervous  shock  of  the  occurrence. 
For  several  days  thereafter  he  was  afraid  to  make  a  fur- 
ther attempt  at  sexual  intercourse,  but  finally  his  de- 
sires overcame  his  discretion,  and  again  there  was  the 
intense  pain  in  the  rectum  and  the  non-emission  ol 
semen,  with  all  the  subsequent  phenomena  which  char- 
acterized the  former  attack.  The  following  morning  he 
came  under  my  notice. 


-.ON-EJACULATK)N    OF   THE    SEMINAL   FLUID.      229 

1..  answer  to  my  inquiries  lie  informed  me  that  he  had 
passed  a  full  stream  of  urine  ever  since  the  first  attack  and 
that  he  had  never  suffered  from  gonorrhoea  or  any  other 
venereal  disease.  On  examination  with  sounds  I  found 
that  there  was  no  evidence  of  a  stricture ;  I  therefore  came 
to  the  conclusion  that  his  case,  like  the  other,  was  one  of 
spasmodic  contraction  of  the  urethra  and  of  the  muscles 
of  the  perineum.  1  treated  him  with  electricity  as  in  the 
foregoing-  instance,  giving  him  the  current  from  ten  cells 
daily  for  about  tive  minutes.  This  was  continued  for 
two  weeks.  At  the  end  of  that  period  he  made  another 
attempt  at  sexual  intercourse,  but  owing  to  the  condi- 
tion of  his  mind  and  his  apprehension  that  the  pain 
would  return  he  was  unable  to  obtain  an  erection.  The 
next  day,  however,  he  met  with  better  success,  and 
this  time  witKout  pain,  and  with  a  free  ejaculation  of  se- 
men. 

This  condition  appears  to  present  some  analog}'  with 
the  spasm  of  the  urethra  sometimes  observed  in  nervous 
individuals  and  which  prevents  them  passing  urine 
while  the}'  are  particularlv  desirous  of  so  doing.  They 
will  stand  sometimes  for  an  hour  with  the  bladder 
nearly  full,  making  every  effort  to  evacuate  it  and  yet 
unable  to  cause  a  single  drop  to  flow. 

Again,  it  presents  some  features  similar  to  the  state 
called  by  Sir  James  Paget*  ''  Stammering  with  the 
urinary  organs,"  but  the  cases  that  he  adduces  and  the 


Surgical  Lectures  and  Essays.     New  York,  1875,  page  77. 


230  SEXUAL    IMIMJIKNCK    IX    Till-;    MAl,i:. 

remarks  he  makes  upon  them  are  intended  to  refer  en- 
tirel}'  to  the  bladder,  as  the  following  remarks  show  : 

"  Stammering-  urinary  organs  are  not  rare,  and  they 
may  be  known  by  observing  sometimes  in  the  same  per- 
son the  exact  parralleb'sm  between  the  difficulty  of  ex- 
pelHng  urine  and  that  of  expelling  the  air  in  ordinary 
speech-stammering.  The  patient  can  often  pass  his 
urine  without  any  trouble,  especially  at  customary 
times  and  places,  and  when  he  does  so  the  stream  is  full 
and  strong.  But  at  other  times  he  suffers  all  the  distress 
that  he  might  have  with  a  very  bad  urethral  stricture. 
He  cannot  pass  a  drop  of  urine  ;  or  after  a  few  drops 
there  comes  a  painful  check,  and  the  more  he  strains 
the  less  he  passes,  and  then  complete  retention  may 
ensue,  and  overfilling  of  the  bladder.  In  their  charac- 
ters the  cases  may  closely  resemble  one  of  the  ordinary 
instances  of  so-called  congestive  stricture,  in  which  rapid 
swelling  of  some  part  of  the  mucous  membrane  narrows 
or  closes  the  part  of  the  canal  which  is  least  capable  of 
distention.  But  the  circumstances  with  which  the  diffi- 
culty arises  are  in  the  two  patients  very  different.  The 
stammering  with  the  bladder  occurs  with  just  the  same 
condition  as  the  stammering  speech.  There  are  few 
stammerers  in  speech  so  bad  but  that  they  can  talk  or 
read  fluently  when  they  are  alone  or  with  those  with 
whom  they  are  most  familiar,  or  when  they  are  entirely 
thoughtless  as  to  their  manner  of  speaking.  Their  worst 
times  are  when  with  strangers  or  with  persons  or  in 
places   that  are   associated    in  their  minds  with  stam- 


NON-EJACULATION    OF    THE    SEMINAL    FLUID.      23I 

mcring.  It  is  just  so  with  the  bladder  at\d  iDethra. 
One  patient  told  me  that  although  he  could  usually 
pass  urine  well,  yet  there  was  one  person  with  whom 
nothing  could  induce  him  to  walk,  because  once  when 
he  was  with  her  he  wanted  to  pass  urine,  retired  and 
failed.  His  experience  of  the  effects  of  association  oi 
thoughts  made  him  sure  that  if  he  were  again  in  the 
same  circumstances  the  same  distress  would  come  on 
him  more  intensel}'.  Another,  a  clergyman,  always 
passed  a  catheter  before  going  into  his  pulpit.  He  had 
often  had  nervous  trouble  with  his  bladder;  and  once 
or  more  having  felt  a  horrid  need  of  passing  urine  while 
he  was  preaching,  he  found  himself  at  the  end  of  his 
sermon  unable  to  pass  any.  He  said  he  felt  sure  that 
if  he  were  to  go  to  his  pulpit  without  the  assurance 
of  an  empty  bladder,  which  his  catheter  (a  No.  12; 
passed  easily)  gave  him,  lie  should  be  possessed  with  a, 
desire  to  pass  urine  and  tlien  should  have  retention. 
Asa  speech-stammerer  might  be  unable  to  utter  a  woid, 
so  would  he  be  unable  to  pass  a  drop  of  urine  again. 
Another  patient  has  described  himself  as  driven  to  all 
kinds  of  devices  to  bring  about  an  association  of  ideas 
or  of  actions  with  which  to  best  succeed  in  emptying 
his  bladder.  He  must  walk  up  and  down  his  room  and 
stand  or  sit  in  some  customary  singular  po.sition.  and 
then  be  ver}'  careful  not  to  direct  his  mind  either  too 
much  or  too  little  to  what  he  has  to  do.  and  then  to  lei 
the  urine  run  as  inconsiderately  as  he  can." 

Sir  James  is,  1  think,  mistaken  in  locating  this  trouble 


232  SEX  LAI.    IMFOiEiNCE    IN    THE    MALE. 

ill  the  bladder.  It  is  undoubtedly  due  to  a  spasm  of  the 
arofanic  muscular  tibres  of  the  urethra  and  of  the  com- 
pressor  urethrse  muscle.  It  is  exactly  similar  to  the 
condition  sometimes  excited  in  nervous  individuals  by 
attempts  to  pass  a  bougie.  The  canal  closes  tightly 
against  the  point  of  the  instrument,  but  a  steady  gentle 
pressure  continued  for  a  few  minutes  usually  overcomes 
the  obstruction.  The  remarkable  fact,  one  which  all 
physicians  and  surgeons  have  observed,  is  that  the  con- 
dition should  be  excited  by  mental  influences  and  certain 
associations  of  ideas.  I  have  known  men  who  could  not 
urinate  when  asked  to  do  so,  unless  the  water  above  the 
urinal  were  allowed  to  run  at  the  same  time,  so  that 
the  idea  of  a  flowing  stream  should  be  excited  in  their 
iiiinds.  The  fact  is  common  enough,  and  it  is  one  well 
known  to  people  generallv.  I  recollect  when  a  college 
boy  being  witness  to  a  wager  between  two  men  that 
one  of  them  could  not  urinate  in  the  other'shal.  A  ring 
()i  curious  spectators  was  formed  around  the  individual 
desirous  of  exhibiting  his  powers  of  urination  ;  he  had  a 
full  bladder,  he  said;  he  prepared  himself,  held  the  hat 
of  his  adversary  in  his  hand,  but  not  a  drop  would  come 
and  the  more  the  lookers-on  laughed  and  cheered,  and 
the  more  he  strained  the  less  real  ability  he  seemed  to 
exhibit.  At  last  the  referee  announced  that  the  time,  a 
half  an  hour,  was  up,  and  he  lost  his  bet  without  having 
passed  a  single  drop.  Five  minutes  afterward,  in  the 
solitude  of  a  woody  lane,  he  evacuated  over  a  pint. 
Such  conditions  remind  us  forcibly  of  those  states  of 


N()\-EJACULATION    OF   THE    SF.MINAL   FLUID.      233 

impotence  considered  in  the  precedingchapter  in  which 
certain  associations  of  ideas  are  necessary  to  the  physio- 
logical performance  of  the  sexual  act. 

Relative  to  the  non-ejaculation  of  the  semen,  to  w-hich 
the  foregoing  remarks  apply,  the  state  has  been  con- 
founded with  another,  aspermatism,  to  which  attention 
will  presently  be  directed,  but  which  is  quite  a  different 
condition. 

The  emission  of  the  semen  may  fail  to  occur  in  con- 
sequence of  paralysis  of  the  compressor  uretlircc  muscles^ 
by  which  condition,  though  it  is  deposited  in  the  urethra, 
it  is  not  ejaculated  from  the  meatus,  but  after  some 
time  slowly  oozes  out.  Acton  regards  this  state  as  due 
a  lack  of  consentaneous  action  on  the  part  of  the  several 
factors  which  go  to  make  up  the  orgasm ;  but  it  is'verv 
evident,  I  think,  that  the  explanation  I  have  given  is 
the  correct  one.  That  the  semen  enters  the  urethra 
at  the  time  of  the  orgasm  I  have  ascertained  in  several 
cases,  of  which  the  following  is  an  example: 

A  gentleman  who  had  long  been  engaged  in  literary 
pursuits,  and  whose  habits  were  sedentary,  became  the 
subject  of  spinal  irritation.  He  consulted  me  a  few 
days  before  his  marriage,  and  I  found  tenderness  over 
the  spinous  processes  of  the  lower  dorsal  and  lumber 
vertebrae,  with  great  muscular  weakness  of  the  lower 
extremities.  He  had  occasionally  suffered  from  noc- 
turnal emissions,  had  never  had  sexual  intercourse,  and 
denied  masturbation  very  energetically.  As  he  was 
about  being  married  he  preferred  to  delay  anv  active 


234  SEXUAL   IMPO'lEXrK    IN    THE    .MALE. 

treatment  until  alter  that  event  had  taken  place.  I  there- 
f(jre  did  nothing  for  him  beyond  prescribing  a  chal_y- 
beate  tonic.  A  month  afterward  he  returned  for  treat- 
ment, and  -then  he  informed  me  that  though  he  had  had 
erections,  and  that  though  so  far  as  he  knew  the  sexual 
orgasm  was  complete,  yet  that  there  had  never  been  a 
seminal  emission  during  the  act  of  intercourse.  But 
immediately  after  withdrawal  the  semen  began  to  flow, 
and  it  continued  to  pass  out  slowly  for  several  hours. 
He  had  ascertained  that  by  pressing  the  fingers  along 
the  course  of  the  urethra  on  the  under  surface  of  the 
penis,  he  could  cause  the  flow  to  take  place  more  rapidly. 

Upon  introducing  a  sound  1  found  that  the  urethra  was 
in  a  healthy  condition  as  regarded  size  and  sensibility, 
and  I  could  find  no  cause  for  the  trouble  beyond  a  pos- 
sible paralysis  of  the  ejaculatory  muscles.  I  treated  him 
with  galvanism  and  faradism  internally  applied,  together 
with  counter-irritation  to  the  spine,  and  the  internal  ad- 
ministration of  iron,  quinine  and  strvchnia.  and  after 
about  two  months  he  began  to  improve,  but  it  was  a 
year  before  the  ejaculation  took  place  with  anv  force. 

I  have  had  quite  a  number  of  cases  similar  to  the  fore- 
going, but  not  of  so  severe  a  character,  in  men  of  ad- 
vanced 3'ears,  in  whom,  though  there  were  emissions  of 
semen,  yet  they  were  not  complete,  a  portion,  often  more 
than  two  thirds  remaining  in  the  urethra  and  gradually 
oozing  out  during  an  hour  or  so.  These  cases  are 
generally  improved  by  electricity,  though  occasionally 
they  resist  all  treatment. 


NON-EJACULATION    OF   THE    SEMINAL   FLUID.      235 

Acton"^'  gives  the  following  case  as  occurring  in  his 
practice :  "  The  patient  was  an  American.  Erection 
was  perfect,  but  emission  did  not  follow.  When  erec- 
tion ceased  there  was  occasionally  a  slight  oozing  from 
the  urethra.  Strange  to  say,  this  patient  had  emissions 
at  night  once  or  twice  a  week.  The  testicles  were  small. 
A  short  time  since  he  had  been  operated  upon  for 
varicocele  without  any  good  effect.  He  had  also 
been  cauterized.  Slight  stricture  existed,  as  was  ascer- 
tained by  the  bulbous  instrument,  but  a  conical  bougie 
passed  easily.  In  this  instance  there  was  apparently 
nothing  but  a  want  of  consentaneous  actions  between 
emission  and  erection,  both  being  perfect  at  different 
times." 

A  very  slight  examination  of  this  case,  as  detailed, 
suffices  to  show  that  Mr,  Acton's  f  explanation  of  it  is 
not  correct.  If  the  emission  had  been  pei-fect  the  patient 
would  have  had  the  semen  discharged  as  in  the  normal 
manner  instead  of  its  oozing  out  gradually  in  the  way 
stated.  The  condition  was  nevertheless  one  in  which, 
as  in  the  case  I  have  given,  the  discharge  took  place 
without  there  being  sufficient  strength  in  the  muscles 
to  force  it  to  the  orifice  of  the  urethra. 

MM.  Grimaud  de  Caux  and  Martin  Saint-Ange :}:  have 
a  clear  idea  of  such  instances,  as  is  seen  in  the  following 
quotation  which  I  make  from  their  work : 


*"  The  Functions  and   Disorders  of  the   Reproductive  Organs,"  etc. 
Fourth  American  edition,  Philadelphia.  1875,  page  223. 
f  Op.  cit.  page  340.  X  Op.  cit.  p.  340. 


236  SEXUAI,    IMPOTENCE    IN    THE    MALK. 

•'  As  we  have  seen,"  they  say,  "there  exist  in  relation 
with  the  penis  certain  muscles,  of  which  some,  as  the 
two  ischio-cavernosa,  are  concerned  with  the  phenomena 
of  the  erection,  and  serve  to  direct  the  organ  in  the 
act  of  copulation,  and  others,  as  the  bulbo-cavernosa  and 
the  constrictor,  compress  the  canal  of  the  urethra,  and 
by  this  means  accelarate  the  flow  of  the  seminal  fluid 
in  the  phenomena  of  ejaculation.  It  often  happens 
that  these  muscles  are  paralyzed  or  that  their  irrita- 
bility is  extinguished.  From  each  of  these  conditions 
it  results  either  that  the  erections  are  incomplete  and 
sexual  in  tercourse  is  thereby  rendered  impossible, 
or  more  frequently  that  the  erection  having  taken 
place  the  seminal  fluid  not  being  submitted  to  the 
action  is  note  jaculated  in  a  duly  physiological  man- 
ner." 

It  is  bad  enough  to  have  this  state  as  a  disease,  but 
it  is  still  worse  to  induce  it  artificially,  as  I  have  known 
to  be  the  case  in  several  instances. 

The  authors  just  cited  state  that  it  is  no  uncommon 
circumstance  for  women  whose  object  it  is  to  prevent 
impregnation,  to  press  during  the  act  of  sexual  inter- 
course upon  the  urethra  of  the  male  just  in  front  of  the 
veru  montanum  in  such  a  manner  as  to  prevent  the 
passage  of  the  semen  through  the  canal,  and  cause  it 
to  be  directed  backward  into  the  bladder.  Eventually, 
as  they  do  not  fail  to  point  out,  the  urethra  acquires  the 
habitude  thus  imposed  upon  it,  and  the  semen  always 
and  under  all  circumstances  passes  into  the  bladder,  tL'.^ 


NON-EJACULATION    OF   THE   SEMINAL   FLUID.      237 

mdividual  becoming  in  consequence  not  only  incapable 
of  physiological  intercourse,  but  sterile. 

I  am  very  sure  that  this  practice  is  followed  to  no 
inconsiderable  extent  at  the  present  day  and  in  this 
country,  but  there  is  another  which  is  sometimes  prac- 
tised which  is  probably  still  worse  in  its  ultimate  conse- 
quences, and  that  is  the  wearing  during  sexual  inter- 
course of  an  india-rubber  ring  around  the  penis  so  as 
to  compress  the  urethra  and  thus  prevent  the  emission 
of  semen.  I  have  known  of  three  instances  in  which 
such  a  contrivance  was  worn,  and  in  each  the  conse- 
quence was  that  the  individual  was  rendered  sterile  by 
the  invariable  passage  of  the  semen  into  the  bladder, 
even  after  the  ring  was  no  longer  worn.  In  one  of 
these  cases  the  patient,  a  married  man,  had  w^orn  the 
ring  at  every  connection  he  had  had  with  his  first  wife, 
who  did  not  desire  children.  After  having  been  mar- 
ried over  ten  years  she  died,  and  in  two  or  three  years 
afterwards  the  man  married  again.  This  time  both  he 
and  his  wife  desired  children,  but  impregnation  was  im- 
possible, for  no  emission  of  semen  took  place  from  the 
meatus,  the  whole  of  it  apparentl}^  passing  back  into 
the  bladder.  That  there  was  semen  was  shown  by  mi- 
croscopical examination. 

Both  the  other  cases  occurred  in  young  men  who  had 
adopted  this  means  of  carrying  on  with  safety  certain 
illicit  relations  which  they  had  formed,  but  in  both  the 
resultant  condition,  as  was  also  the  case  with  the  in- 
stance first  mentioned,  became  permanent.     The  exact 


238  SKXIAI,    IME'UTENXE    IN     I  HE    MALI'.. 

anatomical  alteration  which  is  produced  in  such  cases 
is  not  definitely  known.  I  am  inclined  to  think,  how- 
ever, that  the  pressure  exerted  changes  the  direction  of 
the  seminal  ducts  so  that  the  mouths  are  made  to  open 
backward  toward  the  bladder  instead  of  forward  in 
the  direction  of  the  meatus. 

A  similar  condition  might  be  produced  by  enlarge- 
ment of  the  prostate,  but  none  such  have  ever  occurred 
in  my  experience. 

The  emission  of  semen  may,  strange  as  it  may  appear, 
be  entirely  prevented  by  extreme  erection.  One  such 
instance  only  has  come  under  my  observation,  and  one 
other  only  of  similar  character  has  been  published. 
The  latter,  as  quoted  by  Roubaud  "-*■  from  Cockburn,  is 
as  follows: 

A  noble  Venetian  married  a  young  lady  w-ith  whom 
his  sexual  relations  were  entirely  satisfactory  except  in 
one  respect,  and  this  the  most  essential  of  all,  for  there 
was  not  the  emission  of  a  single  drop  of  semen.  Dur- 
ing the  sleep  that  occurred  after  his  failures  he  had  las- 
civious dreams  with  seminal  emissions,  but  during  inter- 
course there  was  no  such  accompaniment.  x\ll  kinds 
of  remedies  were  used  without  effect,  till  finally  the  an)- 
bassadors  of  the  republic  of  Venice  at  the  several  Euro- 
pean courts  were  requested  to  consult  the  most  famous 
phj'sicians  in  regard  to  the  case.  Among  others  the 
matter  was  laid  before  Cockburn.  who  attributed  the 
difficulty  to  a  too  vigorous  erection,  bv  which  the  walls 

*Op.  cit.  p.  188. 


NON-EJACULATION    OF   THE    SKMINAI,    FUm.       239 

of  the  urethra  were  brought  together.  During  the  las- 
civious dreams  which  took  place,  the  erection,  not  being 
so  strong,  emission  was  effected. 

In  the  case  which  was  under  my  observation,  the 
patient,  a  gentleman  oi  about  forty  years  of  age,  single, 
and  not  excessive  in  sexual  matters  previous  to  the 
occurrence  in  question,  formed  relations  with  a  very 
attractive  young  woman,  wht>  diew  largely  on  his 
virile  power.  After  the  first  connection,  he  never  had 
another,  without  the  erection  being  remarkably  vigor- 
ous, and  lasting  sometimes  an  hour  after  the  act  had 
come  to  an  end.  During  these  connections  not  a  drop 
of  semen  escaped  from  the  urethra,  nor,  so  far  as  I 
could  determine,  was  there  at  such  times  any  passage 
of  the  seminal  fluid  into  the  bladder.  It  appeared  to 
bean  instance  of  what  Roubaud  has  called  aspcnnatism, 
a  condition  in  which  there  is  no  semen,  or  at  least  none 
that  enters  the  uretlira. 

The  patient  did  not  suffer  from  priapism,  for  there 
was  an  excess  of  desire  and  an  apparent  excess  of 
power;  nor  was  he  troubled  with  erections  at  other 
times  than  when  with  his  mistress.  Things  had  gone 
on  in  this  way  for  several  weeks  when,  fearing  that  dis- 
ease of  some  kind  might  be  the  consequence,  he  placed 
himself  under  my  care.  I  did  nothing  for  him  but  give 
him  large  doses  of  the  bromide  of  sodium,  thirty 
grains  three  times  a  day  for  a  week,  and  the  trouble 
gradually  disappeared  within  that  period. 

Priapism  may  lead  to  a  like  result  as  in  the  case  cited 


240       SEXUAL  IMPOTENCE  IN  THE  MALE. 

by  Lallemand*  of  a  soldier  who,  falling  on  the  sacrum 
from  a  height,  had  permanent  erections  without  desire, 
which  no  acts  of  masturbation  or  of  intercourse  sufficed 
to  dissipate,  and  the  orgasms  of  which  were  unaccom- 
panied by  the  ejaculation  of  a  drop  of  semen. 

Relative  to  the  condition  which  he  has  happily  called 
"  aspermatism,"  and  of  which  the  foregoing  are  ex- 
amples, due  to  excessive  erection,  Roubaud  cites  the 
following,  which  occurred  within  his  own  experience  : 

"  A  young  man  twent}-  years  of  age,  of  sound  health 
and  of  a  sanguine  temperament,  consulted  me  under 
the  following  circumstances:  '  I  have,'  said  the  patient. 

*  no  difficulty  in  obtaining  erections :  my  sexual  desires 
are  sufficiently  strong,  but  I  have  never  experienced 
the  pleasures  of  love.  The  intromission  of  the  penis 
into  the  vagina  of  a  woman  is  effected  without  difficult} 
and  without  pain,  but  this  being  accomplished,  I  can 
not,  no  matter  how  strong  efforts  I  may  make,  experi- 
ence the  voluptuous  sensations  of  which  my  friends 
speak.  After  a  longer  or  shorter  period  of  ineffectual  ex- 
ertion, durino;  which  I  call  to  mv  mind  all  the  resources 
of  my  imagination  and  of  my  amorous  energy,  I  be- 
come fatigued,  and  my  penis,  participating  in  the  gen- 
eral state  in  which  I  am,  becomes  flaccid  without  its 
being  possible  to  obtain  an  ejaculation.' 

"  In  the  examination  which  I  made  of  this  young 
man  I  ascertained  that  ejaculations  have  never  taken 
place  while  he  was  awake,  either  by  masturbation  oi 

*  "  Dcs  pertes  seminales  involontaires."    Montpelier.  1836-42,  t.  ii.  p.  64. 


NON-EJACULATION    OF   THE   SEMINAL   FLUID,      241 

by  copuiation,  but  that  sometimes  during  sleep  cither 
under  the  influence  of  lascivious  dreams,  or  without 
them,  there  had  been  an  emission.  About  this,  how- 
ever, there  was  the  curious  circumstance  that,  if  from 
any  cause  whatever  the  patient  awoke  during  the 
ejaculation,  an  immediate  arrest  of  the  process  took 
place,  so  that  he  had  never  obtained  an  idea  of  sexual 
pleasure." 

Roubaud  very  properly,  I  think,  attributes  these  and 
similar  instances  to  the  spasmodic  state  of  the  ejacula- 
tor}'  ducts  by  which  their  orifices  are  closed  and  the 
semen  prevented  passing  into  the  urethra.  There  is 
therefore  no  accumulation  of  this  fluid  in  the  urethra, 
or  passage  of  it  backward  into  the  bladder.  For  its 
treatment,  depending,  as  he  concedes  that  the  condition 
does,  on  excessive  venereal  ardor,  he  recommends  anti- 
spasmodics. Nothing  better  than  some  one  of  the 
bromides  in  full  doses  could  be  desired,  together  with 
the  use  of  galvanism  internally,  appHed  in  the  manner 
already  mentioned. 

In  other  cases  the  seminal  ducts  may  be  obliterated 
through  inflammation,  the  latter  sometimes  doubtless 
produced  by  cauterization  after  Lallemand's  method,  of 
which  MM.  Grimaud  de  Caux  and  Martin  Saint-Ange* 
say  that  "  European  cauterization  makes  more  eunuchs 
than  does  oriental  polygamy." 

Anomalies  of  the  Prepuce.  Phimosis  ma}'  be  so  in- 
tense in  character  as  to  prevent  the  emission  of  semen, 
*Op.  cit.  p.  339. 


24:?  SEXUAL    IMPOTE-NXE    IN   THE    MALE. 

besides  interfering  very  essentially  \\  ith  the  develop- 
ment c.if  the  hill  degree  of  pleasure  attendant  on  the 
act  of  intercourse.  In  such  a  case  the  enlargement  of 
the  penis  during  erection,  meeting  with  the  resistance 
of  the  narrow  prepuce,  causes  a  closure  of  the  urethra, 
ctnd  the  seminal  fluid  is  not  emitted  till  a  state  of  flac- 
cidity  ensues.  Three  such  cases  only  have  occurred 
within  the  range  of  my  experience,  but  I  suppose  it  is 
a  state  not  very  uncommon.  In  one  of  the  instances 
under  ni}'  charge  the  patient,  a  prominent  gentleman  of 
a  neighboring  state,  had  acquired  the  affection  grad- 
ually during  the  two  or  three  years  before  I  saw  him, 
though  he  had  never  had  gonorrhoea,  balanitis,  or  any 
kind  of  preputial  inflammation.  In  the  condition  of 
flaccidity  there  was  no  obstruction  to  the  free  passage 
of  the  urine,  but  when  erection  existed  this  was  not  the 
case,  and  during  the  sexual  orgasm,  though  there  was 
no  pain,  the  ordinary  feeling  of  pleasure  was  much  les- 
sened, and  there  was  no  emission  of  semen  till  the  erec- 
tion passed  off.  I  operated  on  him  by  circumcision 
with  entire  success. 

In  the  other  case  the  patient  w-as  a  young  gentleman 
who  was  about  to  marry,  and  who  had  had  a  contracted 
prepuce  from  childhood.  He  had  never  masturbated 
nor  had  nocturnal  emissions  so  far  as  he  knew,  but 
before  coming  to  see  me  he  had  visited  a  woman  in 
order  to  ascertain  whether  or  not  he  was  capable  of 
performing  the  sexual  act,  having  some  doubt  upon 
the    subject  in  consequence  of  what  one  of  his  medical 


NON-EJACULATION   OF   THE   SEMINAL   FLUID.      243 

friends  had  told  him.  A  few  days  subsequently  he 
came  to  me  with  the  information  that  something  would 
have  to  be  done  to  him  as  in  his  present  condition  there 
was  no  emission  during  intercourse. 

Upon  examination  I  found  that  it  was  impossible  to 
retract  the  prepuce,  and  that  the  glans  was  very  con- 
siderably  smaller  than  it  ought  to  have  been.  1  advised 
an  operation,  to  which  he  at  once  consented,  and  I 
heard  of  no  further  trouble. 

The  condition  in  question,  though  treated  of  at  length 
by  writers  on  the  subject,  in  all  its  other  relations,  does 
not  appear  to  have  attracted  attention  as  a  cause  of  im- 
potence. Its  effect  in  lessening  or  entirely  abolishing 
the  normal  feeling  of  pleasure  experienced  in  sexual  in- 
tercourse will  be  more  appropriately  considered  in  the 
following  chapter. 

TJie  glans  may  be  the  seat  of  ant^stltesia  of  such  a 
character  as  to  interfere  very  materially  with  the  pro- 
duction of  the  orgasm,  and  the  consequent  emission  of 
semen.  This  condition  has  been  mentioned  as  a  cause 
of  deficient  erection;  but  there  is  another  kind,  differ- 
ent perhaps  only  in  degree,  in  which  the  erection  is 
sufficiently  strong,  in  which  the  act  of  intercourse  is 
begun,  but  in  which,  notwithstanding  all  efforts  that 
may  be  made,  there  is  no  orgasm.  This  state  is  due  to 
anaesthesia,  probably  both  to  tactile  and  heat  impres- 
sions. Such  at  least  has  been  the  condition  in  the  cases 
that  have  come  under  my  observation. 

As  the  result  of  many  determinations,  I  have  ascer- 


244  SEXUAT,    TMPOTKNCE    IX    THE    MALE. 

tained  that  in  the  normal  condition  of  Haccidity  the 
o;-lans  is  about  one  fourth  as  sensitive  to  touch  as  the 
end  of  the  index  finger.  On  tlie  latter,  the  two  points 
of  the  aesthesiometer  can  be  distinguished  at  the  dis- 
tance of  J^  of  an  inch.  On  the  glans,  they  cannot  be 
discriminated  at  a  less  distance  than  -^  of  an  inch. 
During  erection  the  sensibility  is  exalted  to  such  a  de- 
gree that  the  two  points  can  be  distinguished  readily  at 
the  distance  of  ^  of  an  inch.  I  presume  that  during 
the  orgasm  the  sensibility  is  still  further  increased. 

Now,  in  the  cases  under  consideration,  in  which  fric 
tion  of  the  glans  against  the  walls  of  the  vagina  does 
not  suffice  to  induce  the  orgasm,  I  have  found  that  the 
points  of  the  aesthesiometer  require  to  be  separated  to 
the  extent  of  ^^  of  an  inch  before  they  can  be  distin- 
guished as  two  distinct  impressions  in  the  flaccid  state 
of  the  penis,  and  that  during  erection  there  is  not  a 
greater  advance  towards  increased  sensibility  than 
such  as  is  shown  by  the  points  being  distinguished, 
though  in  some  cases  not  very  clearly,  at  j\  of  an  inch 
apart. 

Moreover,  in  the  healthy  condition  of  the  flaccid 
penis,  it  is  very  easy  for  differences  of  temperature  of 
live  or  six  degrees  to  be  distinguished,  and  in  the  state 
of  erection  half  this  difference  can  be  readily  determined. 

In  the  anzesthetic  condition,  however,  of  the  flaccid 
penis,  a  glass  cylinder  of  water  at  98°  could  not.  when 
brought  in  contact  with  the  glans,  be  distinguished 
from  one  containing:  w^ater  at  108°.     Durinsr  erection 


NON-EJACULATION   OF    THE    SEMINAL   FLUID.      245 

one  of  98°  could  not  be  recognized  as  different  in  tem- 
perature from  one  of  105".  At  106°  a  difference  could 
be  detected. 

The  condition  in  question  is,  therefore,  I  think,  cer- 
tainly one  of  ancesthesia. 

Electricity  in  any  one  of  its  forms  generally  suffices 
for  the  cure  of  this  derangement  of  the  normal  state. 
Franklinic  electricity  is  to  be  preferred  ;  but,  if  it  is  not 
available,  either  of  the  other  varieties  may  be  emploj-ed, 
and  in  the  manner  recommended  in  the  previous  chapter. 

HypcrccstJicsia  of  the  glans  may  be  so  intense  as  to 
cause  the  emission  and  orgasm  to  take  place  before  en- 
trance is  effected.  In  such  cases  it  is,  of  course,  a  true 
cause  of  impotence.  Usually  this  state  is  induced  by 
excesses  either  of  masturbation  or  of  intercourse,  and 
the  glans  is  thrown  into  such  a  condition  of  irritability 
that  the  reflex  actions  necessary  to  the  orgasm  take  place 
on  the  slightest  provocation.  This  derangement,  as 
well  as  that  of  anaesthesia,  has  already  been  considered 
under  another  head  in  the  previous  chapter.  It  only  re- 
quires notice  here,  not  as  a  cause  of  lack  of  power,  as 
it  is  in  those  instances  in  which  friction  against  the 
clothing,  even  without  sexual  excitement,  is  sufficient 
to  produce  an  emission  with  scarcely  an)-  other  sign  of 
an  orgasm,  but  as  a  cause  of  impotence  when  attempts 
are  made  at  sexual  intercourse  and  the  emission  takes 
place  externally  to  the  vagina.  Of  course,  pathologi- 
cally, the  two  conditions  are  nearly  identical,  that  now 
under  notice  being  only  an  early  stage  of  the  other. 


246  SEXUAL   IMPOTENCE   IN   THE    MALE. 

For  its  treatment  I  have  found  that  the  bromides 
taken  internally,  and  lotions  of  a  solution  of  tannic  acid 
in  water,  in  the  proportion  of  ten  grains  to  the  ounce, 
constituted  the  best  method  of  treatment,  abstinence 
from  sexual  intercourse  for  several  months  being  a 
necessary  adjunct.  The  effect  of  the  tannic  acid  is  to 
decrease  the  sensibility  of  the  terminal  extremities  ot 
the  nerves  in  the  glans,  and  thus  to  render  them  less 
apt  to  be  excited  by  slight  impressions.  Sometimes  the 
affection  is  difficult  of  cure,  and  if  not  taken  in  time  is 
exceedingly  prone  to  pass  into  that  more  advanced 
stage  in  which  frictions  without  venereal  excitement 
are  sufficient  to  cause  an  emission. 

In  addition  to  the  vices  of  conformation,  and  diseases 
to  which  attention  has  already  been  directed,  the  penis 
may  be  the  seat  of  various  affections  which  prevent  intro- 
mission, and  hence  are  causes  of  impotence.  Such 
cases  are,  however,  rare,  and  for  the  reason  that  before 
that  point  is  reached  the  patient  generally  consults  a 
surgeon,  who  performs  whatever  operation  may  be 
necessary. 

The  Testicles. — Diseases  of  the  testicles  are  more  apt 
to  lead  to  sterility  than  to  impotence.  Often,  however, 
both  conditions  exist.  In  so  far  as  they  produce  im^ 
potence  with  or  without  sterility,  they  require  notice 
in  this  connection. 

Absence  of  the  Testicles. — Complete  absence  of  the 
testicles  as  a  congenital  condition  probably  does  not 
exist,    though    numerous    cases   of   the  kind   were   re- 


NON-EJACULATION    OF   THE   SEMINAi;    FLUID.      247 

ported  by  the  older  authors.  Thus  Cabiol  *  describes 
the  case  of  a  young  man  hanged  for  robbery  at  Mon- 
pellier,  and  whose  autopsy  he  conducted.  "  Among 
other  things,"  he  says,  '"the  most  curious  was,  that  no- 
where were  there  any  testicles,  either  externally  or  in- 
ternally, although  we  found  his  vesiculae  seminales  as 
full  of  semen  as  those  of  any  man  I  had  ever  anatom- 
ized. The  fact  astonished  all  who  assisted  in  the  exam- 
ination." 

It  is  now  the  generally  received  opinion  that  when 
the  testicles  are  not  found  in  the  scrotum  they  are 
retained  either  in  the  inguinal  canals  or  somewhere 
within  the  abdominal  cavity.  In  such  instances  it  is 
usually  the  case  that  they  are  atrophied  and  that  the 
sexual  power  of  the  individual  is  very  materially  less- 
ened. In  those  cases  in  which  only  one  testicle  has 
failed  to  descend  into  the  scrotum  the  ability  to  have 
intercourse  is  not  usually  markedly  dinunished,  but 
when  both  have  been  retained  it  is  almost  invariably 
the  case  that  the  individual  has  neither  desire  nor 
power,  neither  orgasm  nor  emission  of  the  semen.  In 
fact,  he  assumes  in  many  respects  the  mental  and  phys- 
ical attributes  of  the  female  sex.  These  phenomena 
are  due,  not  to  the  original  absence  of  the  organs,  but 
to  the  fact  that  owing  to  the  abnormal  position  they 
occupy,  they  have  not  undergone  the  development 
which  occurs  at  puberty,  and  that  consequently  they 
fail  to  secrete  semen.     Besides  this,  the  organs  suffer 

"Quoted  by  Roubaud     Op.  cit.  p.  543. 


248  SEXUAL   niFOTENCE    IN   THE    MALE. 

a  positive  atrophy,  as  indeed  does  ever}-  organ,  the  de- 
velopment of  which  may  be  from  any  cause  arrested. 

But  if  the  individual  should,  after  puberty,  or  even 
shortly  before  that  period,  be  deprived  of  his  testicles, 
though  of  course  sterility  is  the  consequence,  it  is  not 
always  the  result  that  absolute  impotence  supervenes. 
As  we  have  seen  in  the  immediately  foregoing  chapter, 
desire  may  exist.  It  is  equally  a  fact  that  in  certain  rare 
cases  erections  and  the  ability  of  intromission,  with  the 
emission  of  a  fluid — composed  of  the  prostatic  secretion 
that  from  Cowper's  glands,  urethral  mucus,  etc. — may 
take  place  in  individuals  who  have  been  deprived  of 
their  testicles.  In  some  instances  there  is  a  mild  kind  of 
orgasm,  accompanied  by  a  certain  degree  of  voluptuous 
feeling.  Thus,  Sir  Astle}'  Cooper  "^•'  removed  both  tes- 
ticles from  a  man,  and  the  patient  four  days  after  had 
an  emission  of  a  fluid  from  the  meatus  resembling  the 
seminal  liquid. 

"  For  nearly  the  first  twelve  months  he  stated  that 
he  had  emissions  in  coitu,  or  that  he  had  the  sensations 
of  emission.  That  then  he  had  erections  and  coitus  at 
distant  intervals  but  without  the  sensation  of  emission. 
After  two  years  he  had  erections  very  rarely  and  very 
imperfectly,  and  they  generally  ceased  immediately 
upon  the  attempt  at  coitus.  Ten  years  after  the  opera- 
tion he  said  he  had  during  the  past  year  been  only  once 
connected. 

"Twenty-eight  years  after  the  operation  he  stated 

*  "  Diseases  of  the  Testes,"  London. 


NON-EJACULATION    OF   THE    SEMINAL   FLUID.      249 

that  for  years  he  had  seldom  any  erection  and  then  that 
it  was  imperfect,  that  he  had  no  emissions  from  the 
first  3'ear  of  the  operation;  that  he  had  for  many  years 
only  a  few  times  attempted  coitus,  but  unsuccessfully  ; 
that  he  had  once  or  twice  dreams  of  desire  and  a  sensa- 
tion of  emission,  but  without  the  slightest  appearance 
of  it.  The  penis  was  shrivelled  and  wasted.  He  was 
in  the  habit  of  shaving-  once  a  week  and  sometimes 
twice.  His  voice,  naturally  very  feeble,  remained  as  at 
the  time  of  the  operation." 

Such  cases  are,  however,  only  exceptional,  and 
though  in  the  East,  chief  eunuchs  may  have  harems 
and  may  experience  the  shadow  of  desire,  it  is  not  at  all 
probable  that  they  are  actuated  by  an}'  much  stronger 
feeling  than  the  wish  to  make  a  display  of  their  wealth. 

Arrest  of  the  Developnieiit  of  the  Testicles. — After  their 
entrance  into  the  scrotum  the  testicles  may  at  any 
period  of  infantile  life — that  is,  before  puberty — cease 
to  grow,  or  at  least  they  do  not  grow  in  size  or  in  the 
tendency  to  assume  their  proper  function  as  rapidly  as 
should  be  the  case.  As  a  rule  such  a  state,  if  profound, 
passes  to  complete  impotence,  but  there  are  cases  in 
which,  notwithstanding  the  non-development  of  the 
organs,  sexual  intercourse  has  been  begun,  and  under 
its  influence  the  organs  have  grown  until  they  have  al- 
most reached  the  normal  size.  Thus  Wilson  *  relates 
the  case  of  a  gentleman  twenty-six  years  of  age  who 
apphed  to  him  for  advice  relative  to  the  advisability 

*  Lectures  on  the  Urinarj'  and  Genital  Organs,  London,  p.  424. 


250  SEXUAL   IMPOTENCE   IN    THE   MALE. 

of  his  getting  married.  On  examination  it  was  discov- 
ered that  his  penis  and  testicles  were  not  larger  than 
those  of  a  boy  of  eight  years  old.  He  had  never  ex- 
perienced sexual  desires  till  he  became  acquainted  with 
the  lady  whom  he  desired  to  marry.  Then  he  had  had 
erections  and  nocturnal  emissions.  He  married  and 
had  several  children,  and  two  years  afterward  it  was 
found  that  his  testicles  were  nearly  as  large  as  those  of 
an  adult  man. 

Such  cases  are,  however,  quite  exceptional.  I  have 
never  seen  one  of  the  kind.  On  the  other  hand,  1  have 
frequently  been  consulted  by  men  who  were  suffering 
from  an  arrest  of  development  of  the  testicles,  but  not 
to  an  extreme  degree,  supervening,  in  fact,  at  about 
the  age  of  puberty,  in  whom  there  was  some  sexual 
power  and  which  was  capable  of  being  still  further  de- 
veloped by  proper  therapeutical  measures.  Doubtless 
such  cases,  if  left  to  themselves,  especially  with  the 
habits  of  masturbation  or  other  sexual  excess  into 
which  the  individuals  have  fallen,  would  terminate  in 
active  atrophy  and  complete  loss  of  power. 

But,  by  improving  the  habits,  administering  cod  liver 
oil  and  the  hypophosphites  or  phosphorus,  together 
with  a  full  and  nutritious  diet,  and,  above  all,  by  the 
use  of  electricity,  in  the  form  of  galvanism  to  the 
testicles,  after  the  manner  described,  the  relief  of  the 
patient  is  not  a  matter  of  much  ditificulty.  But  it  is 
essential  to  this  result  that  there  should  still  be  some 
desire    or   some    power.       If    both   be    utterly    cxting 


NON-EJACULATION    OF   THE   SEMINAL   FLUID.      2$ I 

uished,  there  is  nothing  to  be  gained  bj  subjecting  the 
patient  to  treatment,  as  the  case  is  certainly  hopeless. 

Atrophy  of  the  testicles  is,  when  established,  a  cause  of 
impotence,  for  which  there  is  no  successful  treatment 
known.  In  the  beginning,  if  the  cause  can  be  ascer- 
tained and  removed,  there  is  some  hope  of  arresting 
the  degenerative  process. 

The  average  weight  of  the  adult  human  testicles  is 
about  five  drachms,  but  it  is  difficult,  if  not  impossible, 
to  determine  the  weight,  during  life,  to  even  an  ap- 
proximation. A  testicle,  however,  weighing  less  than 
three  drachms,  would  certainly  be  in  a  state  of  atro- 
phy ;  more  is  to  be  determined  by  the  size  and  the  con- 
sistency. 

The  most  common  cause  of  atroph}^  of  the  testicle  is 
orchitis,  and  especially,  according  to  my  experience, 
the  disease  supervening  on  parotitis.  The  inflam- 
mation of  the  testicle  accompanying  gonorrhoea  is  not 
usually  situated  in  the  body  of  the  gland,  and  hence  is 
not  so  apt  to  be  followed  by  atrophy.  Blows  and  in- 
juries of  various  kinds  are,  however,  comparatively 
prolific  causes  of  atrophy  from  the  inflammation  which 
they  produce. 

Injuries  or  diseases  of  the  brain  or  spinal  cord  are 
sometimes  followed  by  atroph}^  of  the  testicles.  Many 
cases  in  support  of  these  facts  are  given  by  authors  and 
several  have  come  under  my  own  observation.  In  one 
instance  a  man  was  struck  on  the  back  of  the  head  with 
a    cart-rung  and   although   the   blow  inflicted   no  verv 


252  SEXUAL   IMPOTENCE    IN   THE    MALE. 

severe  injury  on  the  part,  atrophy  of  the  testicles  super- 
vened. In  this  case  the  degeneration  went  on  so 
rapidly  that  at  the  end  of  two  months  there  was  noth- 
ing in  the  scrotum  but  two  masses  of  soft  amorphous 
substance. 

In  another  case  a  man  fell  from  a  perpendicular  bank- 
over  fifteen  feet  high,  and  struck  his  head  violently 
against  the  earth  below.  He  was  taken  up  senseless 
but  soon  recovered  from  the  immediate  effects  of  the 
injury.  Six  months  afterward  he  came  under  my  ob- 
servation and  I  found  that  both  testicles  had  almost 
entirely  disappeared. 

In  the  previous  chapter,  I  have  adduced  several  in- 
stances of  injury  of  the  cerebellum  causing  atrophy  of 
the  testicles  and  impotence.  In  c^riTixw  injuries  of  t!ie 
spinal  cord  <\.\XQ^\\\  oi  the  testicles  is  liable  to  super- 
vene. Cases  have  been  reported  in  which  blows 
on  the  nape  of  the  neck  and  on  the  lumbar  region  of 
the  spine  have  led  to  this  result.  Two  cases  of  the 
kind  came  under  my  notice  several  years  ago,  in  one  of 
which  a  dragoon  fell  from  a  stable  loft  and  struck  the 
lower  part  of  the  spine  against  a  stall-partition.  Para- 
plegia was  the  immediate  result,  and  in  a  few  days  the 
testicles  began  to  atrophy.  In  the  course  of  less  than 
three  weeks  there  were  no  vestiges  of  them  to  be  per- 
ceived. 

In  the  other  case,  a  man  was  shot  in  a  street  fight,  the 
ball  grazing  the  spinous  process  of  the  fourth  lumbar  ver- 
tebra, but  not  inflicting  any  damage  to  the  bone  bev(^n(l 


NON- EJACULATION    OF   THE    SEMl.XAl.    ILUID.      233 

taking-  off  about  half  an  inch  of  its  end.  No  other  in- 
jury resulted  except  atrophy  of  the,  testicles  which  be- 
gan soon  afterward,  and  in  four  or  five  months  had 
become  complete. 

Diseases  of  the  spinal  cord  are  sometimes  followed  or 
accompanied  by  atrophy  of  the  testicles,  but  as  the 
subject  has  already  been  referred  to  in  the  preceding 
chapter,  it  is  not  necessary  to  go  over  the  matter  again, 
further  than  to  say  that  in  some  cases  of  organic  dis- 
eases of  the  spinal  cord,  those  in  which  there  is  great 
reflex  excitability,  as  in  antero-lateral  sclerosis,  and  in 
some  instances  of  congestion,  I  have  seen  patients  suf- 
fering from  atrophy  of  the  testicles  in  a  marked  degree 
and  yet  exhibiting  vQry  decided  sexual  desire  and  pow- 
er of  intromission.  In  one  case  of  the  kind — lateral 
sclerosis — the  testicles  were  not  to  be  distinguished,  but 
the  patient  was  subject  to  the  most  ungovernable  de- 
sires, with  erections,  which  repeated  acts  of  mastur- 
bation and  of  intercourse  failed  to  relieve.  The  condi- 
tion was  quieted  by  the  administration  of  several  doses 
of  the  bromide  of  sodium  of  one  hundred  grains  each. 

The  other  diseases  of  the  testes  do  not  require 
special  consideration.  If  they  are  of  the  nature  of 
malignant  disease  they  require  the  removal  of  the 
affected  organ,  and  even  if  they  are  not,  the  treatment 
comes  under  the  head  of  general  surgery.  The  like  is 
true  of  the  annexse  of  the  testicles. 

Bodily  Deformity  or  Peculiarity.  The  body  may  be  so 
deformed  as  to  render  intercourse  in  the  ordinary  man- 


254       SKXUAI,  IMPOTENCE  IN  THE  MALE. 

ner  impracticable,  owing  to  the  impossibility  of  bring- 
ing the  penis  into  close  relations  with  the  vagina.  Cer- 
tain diseases  of  the  spinal  cord  may  cause  such  extensive 
contractions  of  the  lower  extremities  as  to  produce  this 
result.  Thus,  in  a  case  of  spinal  meningitis  of  a  chronic 
character  under  m}^  charge,  the  right  leg  was  flexed  to 
its  utmost  extent  on  the  thigh,  and  the  thigh  on  the 
pelvis  in  such  a  manner  as  to  cross  the  lower  part  of 
the  abdomen,  while  the  left  leg  and  left  thigh  were 
similarly  contracted,  though  not  to  as  great  a  degree. 
The  consequence  was  that  it  was  impossible  to  ap- 
proach the  female  according  to  the  natural  method,  or 
indeed  after  any  position  so  far  as  I  could  determine. 
The  patient  was  troubled  with  intense  sexual  desire 
and  he  had  frequent  emissions,  but  intercourse  was  im- 
possible. 

In  another  case  the  patient,  a  young  man,  married 
about  two  years,  became  the  subject  of  lateral  spinal 
sclerosis,  and  among  the  symptoms  exhibited  were 
violent  tonic  contractions  of  the  lower  extremities. 
These  contractions  would  last  sometimes  for  two  weeks 
at  a  ti.iie  and  during  their  existence  sexual  intercourse 
was  impossible.  They  were  not  accompanied  with 
pain,  and  as  his  desires  were  strong  and  he  was  at- 
tached to  his  wife,  he  bitterly  lamented  his  condition. 
While  in  the  condition  referred  to,  the  lower  extremi- 
ties Were  drawn  up  strongly  against  the  abdomen,  and 
at  the  same  time  adducted  to  the  utmost  extent.  Many 
attempts  were  made  at  intercourse,  but  the  situation 


NON-EJACULATION    OF   THE    SEMINAL   FLUID.      255 

was  such  that  it  was  quite  impossible  for  the  penis  to 
enter  the  vagina.  At  first  there  were  frequent  inter- 
missions during  which  the  parts  were  straightened  out, 
but  eventually  they  become  permanently  contracted 
and  pressed  forcibly  against  the  abdomen,  rendering 
sexual  intercourse  a  physical  impossibility. 

Tumors  of  the  neighboring  parts  might  act  in  a  simi- 
lar manner,  as  would  also  extensive  elephantiasis  of  the 
scrotum. 

Excessive  corpulency,  as  it  affects  desire  and  power, 
has  already  been  considered,  but  it  still  remains  for  me 
to  notice  it  so  far  as  it  presents  a  physical  impediment 
to  sexual  intercourse.  It  is  obvious  that  with  men  of 
very  enormous  abdomens  intercourse  is  impossible. 
In  speaking  of  this  subject  Roubaud  *  says :  "  The 
sense  of  propriety  and  of  morality  seems  to  revolt 
against  medical  prescriptions  on  the  subject,  and  in 
justification  I  must  support  myself  by  the  authority  of 
Lisfranc.  '  We  can,'  he  says,  '  to  make  things  easy  for 
married  people,  permit  the  positions  which  are  most 
agreeable.  Religion  does  not  interpose  when  the  ob- 
ject in  view  is  the  multiplication  of  the  species.  It  is 
more  contrary  to  the  spirit  of  the  dogmas  of  religion 
to  enjoy  sterile  pleasures  than  to  seek  to  render  them 
fruitful  by  means  which  nature  and  the  instinct  of  all 
animals  indicates.  I  am  not  to  be  understood  as  re- 
commending to  married  people  those  postures  invented 

*  Op.  cil.  205. 


256       SEXUAL  IMPOTENCE  IN  THE  MALE. 

by  the  most  ungovernable  debauchery  and  libertinage, 
which,  so  far  from  curing  sterility,  cause  this  con- 
dition. Let  those  deceitful  attitudes  which  seem  to 
offer  the  image  of  pleasure  to  corrupt  and  withered 
hearts,  remain  in  the  places  where  love  has  never 
entered  without  horror  ;  in  those  places,  where  pleas- 
ure is  a  monster  to  which  sacrifices  are  made,  with  the 
transports  of  madness.  Hymen,  more  anxious  to  give 
energy  to  pleasure  than  to  multiply  the  sacrifices 
which  are  demanded,  banishes  from  his  mysteries 
everything  that  can  give  umbrage  to  modesty  and 
decency — for  they  are  one,  whatever  the  cynic  may  say. 
Every  position  that  tends  to  take  away  from  pleas- 
ure the  fruits  that  belong  to  it  is  contrary  to  natural 
laws,  and  every  one  which  diminishes  the  obstacles  to 
conception  ought  to  be  advised  in  those  cases  that 
require  them.* 

This  appears  to  me  to  be  sound  coctrine  and  at  the 
same  time  in  accordance  not  only  with  the  laws  of 
nature  but  with  those  of  common  sense  and  propriet)^ 
Physicians  are  sometimes  consulted  in  regard  to  this 
matter,  and  it  is  well  that  they  should  be  prepared  to 
give  advice  which  is  in  accordance  with  ph3-siology 
and  decency.  Undoubtedly  all  positions  other  than 
that  which  appears  to  be  instinctive  in  man,  are  inimi- 
cal to  fertility,  but  if  that  posture  be  impossible  b}' 
means  of  physical  impediments  it  is  strictly  in  accord- 

*  "  De  I  Homme  et  de  la  Femme  Consideres  Physiqi:ement  dans  I'Etat 
de  Mariage."     17S4,  t.  i.  p.  3S9. 


NON-EJACULATION    OF   THE    SEMINAL   FLUID.      257 

ance  with  science  to  assume  that  which  is  least  re- 
moved from  the  one  which  propriety  and  nature  indi- 
cate when  they  are  free  to  choose. 

At  the  same  time,  it  appears  proper  to  point  out  that 
some  of  the  attitudes  assumed  during  the  act  of  inter- 
course are  in  the  highest  degree  injurious  as  liable  to 
mduce  diseases  of  great  severity.  In  regard  to  this . 
point  the  citation  of  a  few  authorities  will  perhaps  give 
additional  weight  to  this  statement. 

MM.  Grimaud  de  Caux  and  Martin  Saint- Ange,*  in 
regard  to  the  subject,  say  : 

"  The  generative  act  absorbs  all  the  physical  and 
moral  faculties  ;  it  is  that  in  which  nature  expends  the 
greatest  possible  amount  of  vitality  and  innervation  ;  it 
IS  a  transitory  convulsion,  a  short  accession  of  epilepsy, 
which  for  the  moment  overpowers  all  the  muscular 
torces.  Consequently  it  is  dangerous  to  indulge,  with- 
out taking  into  account  all  individual  conditions  of 
time,  circumstance,  and  even  of  place  and  position. 

'•  Let  us  see  what  the  treatises  on  physiology  tell  us 
in  regard  to  the  muscular  power  put  in  action  in  order 
to  keep  an  individual  in  the  erect  posture.  First, 
there  is  the  head,  which  bv  its  weight  tends  to  fall  for- 
ward. It  is  necessar}'  to  restrain  it  by  attacliing  mus- 
cles to  its  posterior  part.  Then  there  is  the  vertebral 
column,  wdiich,  besides  carr3-ing  the  head,  supports 
also  the  chest  and  abdomen.  These  organs,  like  the 
head,  tend  to  fall  forward,  and  so  are  held  in  jiosition 

*"  Histoire  de  la  Generation  de  I'Homme,"  etc.      Paris,  1847,  P-  257. 


258  SEXUAL   IMPOTENCE    IN    THE    MALE. 

by  the  vertebral  column.  Muscles,  the  most  powerful 
in  the  whole  range  of  animal  mechanics,  occupy  the 
posterior  and  inferior  part  of  the  trunk  to  oppose  this 
tendency,  and  there  is,  besides,  the  pelvis,  which,  in  ad- 
dition to  the  weight  of  its  own  organs,  carries  also  that 
of  the  vertebral  column  and  the  head,  and  which,  with 
all  its  burden,  has  no  other  points  of  support  than  the  two 
round  heads  of  the  femurs  inserted  into  corresponding 
round  cavities.  The  situation  is  manifestly  precarious, 
for  the  relations  of  these  cavities  with  the  heads  of 
the  bones  are  such  as  to  render  every  movement  easy 
of  execution.  We  perceive,  then,  that  the  trunk  is  only 
maintained  in  the  erect  attitude  by  the  observance  of  a 
perfect  equilibrium,  and  this  equilibrium  is  the  result  of 
the  combination  of  a  great  number  of  muscular  actions. 
If  the  power  which  acts  on  the  anterior  part  were  to 
yield,  the  vertebral  column  would  at  once  fall  back- 
ward, and  a  like  movement  would  be  made  to  the  fronr 
if  the  posterior  actions  were  to  to  fail.  It  is  not  neces- 
sary to  pursue  further  the  exposition  of  the  system  ol 
animal  mechanics:  what  we  have  said  is  sufficient  for 
our  object.  It  will  be  readily  seen  that  to  maintain 
the  erect  position  the  co-ordinate  action  of  a  great 
number  of  muscles  is  necessar3%  and  that  the  failure  of 
any  one  of  them  would  inevitably  lead  to  a  fall.  It  is 
therefore  a  matter  of  great  imprudence  to  exercise, 
while  in  this  positions  a  function  which  so  materially 
depresses  tlie  muscular  strength  as  does  the  act  of  sex- 
ual Intercourse. 


NON-EJACULATION    OF   THE   SEMINAL   FLUID.      259 

"The  sitting  posture  presents  inconveniences  less 
numerous  but  quite  as  real  and  as  serious.  In  the  hor- 
izontal position,  on  the  contrary,  there  is  no  muscular 
effort,  the  body  rests  in  its  entire  weight  on  the  plain 
which  supports  it,  and  it  is  this  attitude  which  should 
be  preferred  in  sexual  intercourse.  To  resume  :  the 
act  of  generation  is  one  in  which  all  the  forces  tend 
towards  a  single  aim,  and  the  recumbent  posture  is  the 
most  favorable,  by  reason  of  the  fact  that  it  diverts  no 
muscular  strength  and  imposes  no  muscular  fatigue." 

Sanctorius,*  who,  notwithstanding  the  fact  of  his 
holding  many  absurd  notions,  enunciated  many  sound 
ideas,  says  : 

"  The  use  of  coition  after  meat,  and  standing  is 
doubtful.  After  meat  it  diverts  the  offices  of  the  en- 
trails; standing  it  diverts  the  muscles  and  diminishes 
their  beneficial  perspiration." 

Tissotf  makes  the  following  observations  in  regard 
to  this  subject : 

"  An  able  surgeon  spoke  to  me  one  day  of  a  man 
who  indulged  in  a  singular  taste,  and  who  worshipped 
those  daughters  of  Venus  who  belong  to  the  lowest 
strata  of  life,  only  when  he  could  approach  them  in  the 
street  corners  and  then  in  a  standing  posture.  The 
patient  became  greatly  debilitated,  had  severe  pains  in 


*  ■' Medicina  Statica;  or,  Rules  of  Health,"  etc.  Englished  by  J.  D., 
London,  1676.     Aphorism,  xl.  p.  154. 

f  "  L'onanisme:  Dissertation  sur  les  Maladies  produites  par  la  mastur- 
bation."    Paris,  1S05,  p.  S8. 


26o  SEXUAL    IMPOTENCE    IN    THE    MALE. 

the  regions  of  the  kidneys,  and  atrophy,  or  wasting  oi 
the  thighs  and  legs,  and  paralysis  of  these  parts. 
These  phenomena  appeared  to  be  due  to  the  attitude 
assumed  in  his  acts  of  sexual  intercourse.  He  died 
after  having  been  confined  to  bed  for  six  months,  and 
in  a  condition  equally  calculated  to  inspire  pity  and 
fright.  .  .  . 

"  When  an  individual  loses  his  forces  by  two  chan- 
nels at  the  same  time  the  weakness  is  very  much  in- 
creased. A  person  who  is  standing  or  sitting  has  need 
in  order  to  maintain  himself  in  these  positions,  espe- 
cially the  first,  to  make  use  of  a  great  many  muscles, 
and  this  lessens  the  animal  spirits.  Weak  persons,  who 
cannot  stand  erect  for  an  instant  without  experiencing 
fatigue,  sick  persons  who  cannot  even  sit  without  ex- 
periencing the  same  result,  prove  this  beyond  a  doubt. 
In  lying,  no  expenditure  of  strength  is  necessary.  It  is 
very  certain  that  the  act  of  sexual  intercourse  per- 
formed in  either  of  the  first-named  postures  will  cause 
much  more  exhaustion  than  when  the  attitude  is  that 
of  lying  at  full  length." 

Relative  to  the  special  effects  produced  by  the  stand- 
ing position  in  sexual  intercourse,  Morgagni,*  Gaul- 
thier  de  Claubry,t  Leudet,:}:  and  Ollivier  (d'Angers)  § 

*  opera.     Ep.  62. 

f  Joui'nal  Gencralc  de  la  Soci(ft^  Me'dicale  de  Paris. 

\  "  Recherches  cliniques  sur  la  congestion  de  la  moele  6piniere  a  la 
suite  d'efforts  violentes."     Archives  gdn^rales  de  Medicine,  Mars,  1863. 

§  "  Traile  des  maladies  de  la  moele  epini^re,"  etc.  Troisieme  edition, 
Paris,  1837,  t.  ii.  obs.  Ixxiii.  p.  44. 


NON-EJACULATION    OF    1  HE    SEMINAL    ELL  ID.       201 

have  expressed  themselves  with  decision,  and  the  latter 
gives  tiie  case  of  a  man  who  was  excessive  in  the  matter 
of  sexual  indulgence,  during  which  he  always  assumed 
the  erect  posture.  Since  two  months,  observing  that 
he  was  injuring  himself,  he  became  more  moderate,  but 
still  continued  the  same  fatiguing  posture.  As  a  con- 
sequence, he  was  affected  with  congestion  of  the  spinal 
cord,  with  its  ordinary  concomitants  of  paral3sis  of  the 
lower  extremities,  lumbar  pains,  etc. 

Carre  *  assigns  the  factor  in  question  as  one  of  the 
causes  of  locomotor  ataxia,  when  he  says : 

"  Excess  in  venereal  indulgence,  especially  in  the  ver- 
tical position,  acts  in  the  same  manner  [causing  conges- 
tion of  the  cord,  as  the  first  step  towards  locomotor 
ataxia].  In  the  horizontal  position,  on  the  contrary,  the 
flow  of  blood  is  more  easy,  and  the  effect  less  marked." 

In  my  own  experience  I  have  known,  several  times, 
serious  results  to  follow  the  constant  use  of  the  position 
m  question  during  sexual  intercourse.  In  one  of  these 
instances  the  patient,  an  elderly  gentleman,  who  had 
long  been  addicted  to  the  emplo3^ment  of  the  erect 
posture  in  his  amatory  indulgences,  was,  on  one  oc- 
casion (and,  I  mav  add,  the  last),  seized  with  a  violent 
tremor  in  both  lower  extremities  at  the  occurrence  of 
the  orgasm,  and  this  continued,  without  intermission, 
for  forty-eight  hours.  At  the  end  of  that  time  he  ascer- 
tained that  his  lower  extremities  were  semi-paralyzed, 

*  "  Nouvelles  recherches  sur  I'ataxic  locomotrice,"  etc.  Paris,  1865. 
P-  257- 


262  SEXUAL   IMPOTENCE   IN   THE    MALE. 

and  that  he  had  lost  all  sexual  power.  Under  the  use 
of  strychnia  he  recovered  to  a  great  extent  the  use  ol 
his  limbs,  but  he  has  never  been  able  to  have  intercourse 
since. 

In  another  case  the  patient,  who  had  never  before 
adopted  that  posture,  was  induced  to  do  so  by  a  rather 
lascivious  woman  with  whom  he  was  cohabiting.  The 
effect  was  a  sudden  loss  of  power  in  both  lower  extrem- 
ities, syncope,  lasting  several  minutes,  and  on  recovery 
from  this,  a  partial  paralysis  of  both  lower  extremities 
with  incontinence  of  urine,  owing  to  insufficienc}'  of  the 
sphincter  of  the  bladder.  In  the  course  of  a  few  weeks 
recovery  took  place  under  the  use  of  electricity  and 
strychnia,  except  as  regarded  the  bladder,  the  sphincter 
of  which  still,  after  five  years,  remains  weak. 

From  these  remarks  it  will  be  seen  that  though  we 
are  justified  in  recommending  or  sanctioning  any  pos- 
ture in  sexual  intercourse  which  bodily  peculiarities 
may  render  necessary  for  the  accomplishment  of  the 
act  of  procreating  the  species,  vet,  that  all  changes  from 
the  position  that  physiology  teaches  is  most  suitable  for 
the  ])urpose  are  made  with  risk,  and  that  all  such  d<;\ia« 
ti(^ns  are  otherwise  not  to  be  countenanced. 


INABILITY   TO   EXPERIENCE   PLEASURE.  263 


CHAPTER   IV. 

ABSENCE  OF  THE  ABILITY  TO  EXPERIENCE  PLEASURE 
DURING  THE  ACT  OF  COPULATION  AND  DURING  THE 
EMISSION    OF   THE    SEMEN. 

The  essential  parts  of  an  act  of  sexnal  intercourse  are 
the  emission  of  semen  and  the  experiencing  of  a  sensa- 
tion of  physical  pleasure  for  a  short  period  before  the 
ejaculation  takes  place,  during  its  continuance,  and  for 
a  short  time  after  its  cessation.  This  sensation,  origin- 
ating in  the  glans  penis,  is  not  confined  to  that  part  of 
the  body,  but  extends  to  the  neighboring  regions,  and 
in  some  persons  is  felt  as  a  voluptuous  thrill  through 
the  spine  and  upper  and  lower  extremities.  But  lor 
the  experience  of  these  voluptuous  sensations,  which 
the  average  adult  man  acquires,  it  is  quite  certain  that 
he  would  abstain,  to  a  great  extent,  if  not  altogether, 
from  sexual  intercourse.  But  it  sometimes  happens 
that,  while  the  desires  are  in  general  strong  and  the 
sexual  power  all  that  can  be  desired,  there  is  a  deficiency 
of  pleasurable  feeling  attendant  on  the  ejaculation  of 
the  semen,  and  that  at  times  there  is  a  complete  absence 
of  such  feeling.  This  may  be  either  relative  or  absolute ; 
that  is,  it  may  exist  only  as  regards  some  particular 
woman  or  women,  or  it  may  be  a  permanent  condition  • 
present  at  all  times  of  sexual  interc(7ursc  and  with  all 
women. 


264  sKxiAi.  iMi'(>  ri:.N(i-;  i.\    tiik  male. 

It  is  uncUuibtedly  true  that  with  most  men  the  vvl- 
uptuous  feelings  experienced  during  sexual  intercourse 
vary  greatly  in  accordance  with  the  degree  of  eager- 
ness with  which  any  particular  act  may  be  approached. 
If  the  individual  is  impelled  by  the  emotion  of  love  the 
pleasure  is  infinitely  greater  than  when  he  is  actuatea 
by  a  mere  animal  feeling,  such  as  he  might  experience 
lor  a  prostitute,  or  when  doing  the  duties  of  the  mar- 
rias:e-bed  from  a  sense  of  obligation  from  which  he 
would  gladly  be  relieved.  In  the  one  case  there  is 
desire  stimulated  by  love,  and,  as  a  consequence,  all  the 
physiological  phenomena  of  the  procreative  act  are  of 
the  most  exalted  kind  ;  in  the  other  there  is  sexual  in- 
difference, and  the  legitimate  result  is  not  only  a  mini- 
mum of  pleasure,  but  also  a  diminution  of  the  other  ac- 
companiments of  copulation. 

For  this  condition  there  is,  of  course,  no  remedy 
which  the  physician  can  apply.  In  fact  it  is  not  in  any 
respect  pathological,  and  though  patients  often  consult 
us  in  cases  of  this  kind,  ignorant  of  the  physiology  of 
the  subject,  the  functions  of  the  medical  adviser  are 
fulfilled  when  he  gives  them  a  little  instruction  in  regard 
to  the  laws  of  their  being  and  some  advice  relative  to 
the  influence  that  might  be  exerted  through  the  emotion 
of  love.  The  matter,  in  fact,  is  one  which  is  entirely 
within  the  control  of  the  patient,  unless,  indeed,  there 
be  some  other  manifestation  than  deficiency  of  pleasure. 

But  in  the  other  kind,  that  in  which  there  is  deficient 
pleasure  under  all  circumstances  of  love  or  variety,  the 


INAlirLITV     TO    EXPERIENCE    PLEASURE.  265 

State  is  abnormal,  and  is  a  proper  instance  for  medical 
intervention.  In  cases  of  the  kind  the  patient  is  actu- 
ated by  affection  as  well  as  by  animal  passion,  the  desire 
is  powerful,  the  erections  are  vigorous,  and  yet  the 
orgasm,  perfect  in  all  other  respects,  causes  little  or  no 
pleasure.  The  condition  is  analogous  to  loss  or  impair- 
ment of  the  sense  of  taste.  In  such  mstances  the  tactile 
sensibility  of  the  tongue  is  unaffected,  but  the  gustatory 
faculty  is  lessened  or  abolished.  In  the  other  category 
of  cases  the  sensibility  of  the  glans  to  fi"iction  is  un- 
diminished, but,  either  the  nerves,  which  are  concerned 
in  the  transmission  of  the  pleasurable  sensations,  have 
had  their  impressionabilitv  obtunded  or  there  is  some 
derangement  of  the  nerve  centre  in  relation  with  these 
nerves.  In  other  words,  the  trouble  is  either  in  the 
penis  or  it  is  in  the  brain. 

Now,  as  regards  the  ordinary  sensibility  of  the  glans, 
and  its  capacity  for  being  excited  by  friction,  there  is, 
as  I  have  said,  in  these  cases,  no  derangement.  It  is 
probable  that  the  centre  for  this  action  resides  in  the 
spinal  cord,  and  that  the  centres  for  erection  and 
excitability  bv  ideation,  as  well  as  that  for  j^leasure, 
reside  in  the  cerebral  cortex..  For  the  due  physiological 
functionation  ot  this  centre,  two  anatomical  points  must 
be  in  a  normal  condition :  the  nerves  in  which  the  sen- 
sation originates,  and  by  which  it  is  transmitted  to  tha 
brain,  and  the  cortical  centre  by  which  it  is  received 
and  appreciated.     If  either  ol  these  be  diseased  or  tem^ 


266  SEXUAL    IMPOTENXE    IN    THE    MALE. 

porarily  deranged,  the  function  will  be  correspondingl}- 
im  paired. 

The  actions  of  certain  drugs  afford  us  valuable  in- 
formation in  regard  to  the  subject.  Thus,  cantharides 
may  produce  priapism  and  strong  desire,  sometimes 
reaching  to  the  extent  of  veritable  insanity,  and  yet  the 
pleasure  derived  from  the  sexual  act,  or  that  of  mastur- 
bation, is  very  slight,  and  often  is  not  experienced  at 
all.  In  other  cases,  it  excites  priapism,  without  either 
desire  for  the  act  of  intercourse,  or  pleasure  during  its 
performance.  Thus,  Stille*  quotes  Dieu  to  the  effect 
that,  while  in  twentv-fivc  cases  in  which  the  drug  was 
administered,  priapism  was  a  constant  occurrence,  and 
sexual  desire  was  very  rare,  in  a  case  of  poisoning  by 
this  drug,  in  a  man,  which  came  to  my  knowledge, 
though  the  patient  was  not  under  my  charge,  it  was 
stated,  that  while  the  individual  had  intercourse  with 
his  wife  thirty-one  times  in  a  single  night,  besides 
masturbating  frequently,  there  was  intense  desire  and 
permanent  priapism,  though  there  was  entire  absence 
of  pleasure. 

Again,  in  priapism  due  to  central  disease,  there  is 
often  a  tendenc}^  to  sexual  intercourse,  toward  which 
the  individual  feels  impelled,  but  from  which  he  derives 
no  pleasure.  In  a  previous  chapter.  I  have  cited  a  case 
from  Lallemand  to  this  effect,  and  there  are  many 
others  that  could  be  adduced. 

*  Therapeutics  and  Materia  Medica.     Philadelphia.  1SA4.  vol.  i    p.  355. 


INABILITY   TO    EXPERIENCE   PLEASURE.  267 

It  is  seen,  therefore,  that  the  centres  for  erection  are 
different  from  those  for  pleasure,  and  that  there  is, 
probably,  a  special  set  of  nerve-fibres  in  the  glans,  and 
other  parts  of  the  penis,  whose  function  it  is  to  be  ex- 
cited to  the  point  of  causing  them  to  transmit  pleasura- 
ble sensations  to  the  brain. 

When  proceeding  from  a  centric  cause,  the  loss  of 
pleasure  during  sexual  intercourse  is  unaccompanied  by 
other  abnormal  phenomena,  and  when  there  is  no  feel- 
ing of  satiety,  indifference  or  disgust,  it  is  almost  always 
attended  by  certain  symptoms  of  disordei-ed  brain- 
action.  Cases  of  the  kind  usuall}-  occur  in  men  who 
have  severely  overtaxed  their  brains,  and  who,  in  con- 
sequence, are  less  impressionable  than  when  in  a 
normal  state.  The  same  persons,  frequently,  do  not 
appreciate  the  flavor  of  different  articles  of  food  ;  they 
complain  that  "  things  do  not  taste  to  them  as  they 
did  ;"  thev  may  even  lose  the  appreciation  of  things  of 
beauty  which  once  would  have  infallibly  delighted  them, 
and  music  no  longer  gives  them  pleasure.  These  are 
the  indications  of  an  exhausted  brain,  and  there  are 
others  of  a  more  local  character,  such  as  pain  in  the 
head,  vertigo,  and  an  inability  to  concentrate  the  mind, 
which  are  generally  present. 

Such  cases  require  moderate  sexual  indulgence,  a 
cessation  of  the  excessive  mental  work,  in  which  the 
patient  is  engaged,  and  a  mode  of  life  calculated  to  give 
the  brain  a  change  from  the  labor  to  which  it  has  be- 
come  habituated.     At  the  same  time,  medical  treatment 


26S  SEXUAL    IMPOTENCE    IX     THE    MALE. 

will  generally  be  of  very  decided  service,  and  tlvs 
should  consist  mainly  of  cod-liver  oil,  strychnia,  iron 
and  quinine.  The  strychnia  may  be  advantageously 
<riven  according  to  either  of  the  formula  already 
specified,  and  in  gradually  increasing  doses,  up  to  ihc 
twenty-fourth  or  twentieth  of  a  grain.  The  othci- 
a-emedies  have  nothing  special  about  rheir  administra- 
tion. 

The  diet  ought  to  be  full  and  nutritious,  animal  food 
forming  a  considerable  proportion  of  it,  and  a  glass  or 
two  of  Bordeaux  or  Burgundy  at  dinner  will  generallv 
^rove  of  service.  Moderate  physical  exercise  cannot 
be  dispensed  with,  it  is  very  certain  that  sedentarv 
pursuits  interfere  materially  with  the  development  of 
pleasurable  sensations  during  sexual  intercourse,  main- 
ly, probably,  for  the  reason  that  such  work  is  chiefly  of 
3.  mental  character.  On  the  other  hand,  excessive  bodi- 
ly exertion  is  still  more  prejudicial  to  the  production  of 
the  full  physiological  feeling.  I  have  had  gentlemen 
addicted  to  severe  athletic  exercises  tell  me,  that  one  ol 
the  results  was  the  decided  diminution  of  the  voluptu- 
ous sensations  of  copulation.  The  element  of  fatigue, 
mental  or  physical,  is  antagonistic  to  sexual  enjoy- 
ment. 

Again,  there  are  cases  in  which  mental  pre-occupa- 
tion  is  fully  as  efficacious  in  destroying  pleasure,  as  we 
have  already  seen  that  it  is,  in  abolishing  desire  and 
power.  If  there  are  engrossing  subjects  engaging  the 
attention,  other  than  that  which  ought  to  be  promin 


INABILITY    TO    EXPERIENCE    PLEASURE.  269 

entiv  in  the  mind  of  the  individual,  it  is  very  certain  that 
the  pleasure  of  the  act  will  be  at  its  minimum. 

In  the  other  form  of  the  affection,  the  seat  api)ears  to- 
be  in  the  penis.  The  desire  is  strong,  the  power  sufifi- 
cient,  the  mind  is  in  concurrence,  the  emission  and  the 
orgasm  occur,  and  yet  there  is  scarcely  the  vestige  of  a 
voluptuous  sensation.  Instances  of  the  kind  are  quite- 
common  and  they  are  most  apt  to  be  met  with  in  those 
who  have  been  excessive  in  sexual  indulgenge.  That 
this  is  a  cause  can  be  readily  ascertained  by  question- 
ing those  persons  who  have  had  repeated  connections 
in  the  course  of  a  single  night,  or  other  short  period  of 
time.  The  information  is  invariably  given,  that,  though 
the  pleasurable  feeling  was  great  dui'ing  the  first  act, 
it  graduall}'  became  less,  till,  after  half  a  dozen  or  more, 
there  was  no  longer  the  slightest  degree  of  enjoyment 
accompanying  the  performance. 

Again,  it  is  a  normal  circumstance,  that,  as  the  indi- 
vidual advances  in  life,  after  he  passes  about  the  forty- 
fifth  or  fiftieth  year,  the  sensibility  of  the  nerves  of  the 
glans  becomes  blunted,  and  the  pleasure  of  the  act  of 
sexual  intercourse  is,  accordingly,  correspondingly 
lessened.  Physicians  are  constantly  consulted  in  re- 
gard to  these  cases,  by  men  who  cannot  be  satisfied 
with  the  condition,  though  it  is  as  natural  as  gray  hair 
or  a  wrinkled  face.  Nothing,  so  far  as  I  know,  can  be- 
done  to  restore  the  sensibility  of  youth. 

And  there  are  persons  in  whom  the  voluptuous  sen- 
sations ordinarilv  experienced,  are  inherently  deficient. 


2/0  SEXUAL   IMPOTENCE    IN   THE    MALE. 

They  are,  for  the  most  part,  individuals  who  have  not 
only  been  chaste  in  act,  but  also  in  thought.  For  such, 
time  and  opportunity  will  be  all  that  are  necessary  to 
develop  the  feeling  to  its  normal  standard.  But  for 
those  who  cannot  allege  chastity  as  the  cause,  the  pros- 
pect of  relief  is  not  so  promising.  These  subjects 
appear  to  be  analogous  to  those  who  are  blind  to  cer- 
tain colors,  deaf  to  certain  sounds,  or  whose  gustatory 
nerves  cannot  appreciate  certain  flavors,  or  whose 
olfactory  nerves  cannot  distinguish  certain  odors.  1 
have  only  met  with  one  such  case,  and,  I  presume,  they 
are  exceedingly  rare. 

The  instance  in  question  was  that  of  a  gentleman 
about  thirty  years  of  age,  a  manufacturer  of  silver- 
ware, and  in  excellent  health.  In  his  youth  he  had 
never  masturbated,  though  he  had  had  repeated  emis- 
sions during  sleep.  At  the  age  of  twenty-five,  he  mar 
ried  a  healthy  and  vigorous  lady  live  years  his  junior, 
to  whom  he  was  much  attached.  On  his  wedding- 
night,  he  had  intercourse  which  was  characterized 
by  an  emission,  attended  with  the  ordinary  convulsive 
movements,  but  without  the  least  sensation  of  pleasure. 
In  the  morning,  feeling  a  strong  desire,  and  having  a 
vigorous  erection,  he  again  had  connection,  but  agairi 
there  was  no  pleasure.  There  was,  he  said,  a  cer- 
tain degree  of  mental  satisfaction  almost  amounting 
to  positive  enjoyment  on  both  occasions,  but  not  the 
slightest  feeling  in  the  glans  or  in  any  other  part  of  the 
body. 


INABILITY  TO  EXPERIENCE  PLEASURE.     27 1 

Previous  to  his  marriage  he  had  never  had  sexual 
intercourse,  although  he  was  frequently  visited  by 
strong  desires  and  erections.  A  high  sense  of  morality 
restrained  him  from  an}'  illicit  indulgence.  About 
once  in  ten  days  he  had  had  an  emission  at  night,  but 
though  he  alwa3S awoke  at  the  time,  he  had  never  been 
conscious  of  any  pleasurable  feeling  attendant  on  the 
orgasm. 

He  had  frequently  heard  the  sexual  act  spoken  of  as 
one  attended  with  very  intense  pleasure,  and  hence 
upon  his  marriage  he  had  to  admit  a  certain  degree  ot 
disappointment.  So  far  as  his  wife  was  concerned 
everything  was  satisfactory.  The  trouble,  he  was  con- 
vinced, resided  entirely  with  himself. 

It  was  about  six  months  after  his  marriage  that  he 
consulted  me.  His  wife  was  then  far  advanced  in 
pregnancy,  so  that  there  could  be  no  question  in  regard 
to  his  sexual  ability.  On  examination  I  could  detect 
no  sign  of  disease  or  derangement  in  any  part  of  the 
sexual  apparatus.  The  glans  appeared  to  be  endowed 
with  the  normal  degree  of  tactile  sensibility  and  sensi- 
bility to  heat  and  pain.  It  was  onl}'  the  sensibility  to 
venereal  excitement  that  was  absent. 

I  advised  electricity — galvanism — applied  daily  to  the 
glans  by  means  of  a  wet  sponge,  and  also  faradism 
through  the  medium  of  water.  But  after  six  months' 
use  of  these  agents  there  was  no  improvement,  and  he 
discontinued  them.  Several  years  have  now  elapsed. 
He  has  three  children,  but  he  tells  me  that  never  once 


2-j2  SEXUAL    IMPOTENCE    IN    THE    MALE. 

has  sexual  intercourse  given  him  any  more  pleasure 
than  the  feeling  of  bicn  aise,  of  which  he  formerly 
spoke. 

I  am  inclined  to  think  that  the  operation  of  ciraini- 
cision,  when  performed  in  early  life,  generally  lessens 
the  voluptuous  sensations  of  sexual  intercourse,  and 
that  even  when  done  in  later  years  the  same  result 
sometimes  follows.  In  regard  to  the  former  point  it  is 
almost  impossible  to  arrive  at  positive  conclusions,  ow- 
insf  to  the  want  of  a  fixed  standard.  It  is  something 
like  the  question  which  some  two  or  three  hundred 
years  ago  agitated  medical  philosophers ;  that  is, 
whether  the  man  or  the  woman  had  the  more  pleasvire  in 
the  act  of  sexual  intercourse  ?  After  wasting  elaborate 
arguments  on  one  side  and  the  other,  the  problem  re- 
mained as  undetermined  as  ever,  and  it  alwavs  must  be 
unsolvable,  unless  we  can  be  men  and  women  alternate- 
ly. 

But  the  information  afforded  us  by  some  who  have 
been  circumcised  soon  after  puberty,  and  who  have 
subsequently  indulged  in  sexual  intercourse,  is  to  the 
effect  that  when  there  had  been  a  possibility  of  uncover- 
ing the  glans  during  intercourse,  the  operation  had  very 
decidedly  diminished  the  voluptuous  feelings  afterward 
experienced.  In  the  cases  where  there  had  been  no 
possibility  of  retracting  the  prepuce,  the  operation  has 
not  only  increased  the  pleasure,  but  has  in  some  cases 
developed  it  from  nothing. 

I  believe  that  nature  intended  the  glans  to  be  habitually 


INABILITY    TO    EXPERIENCE   PLEASURE.  273 

nearly  covered  by  the  prepuce  when  the  penis  is  in  a 
non-erect  state,  and  that  this  is  necessary  for  the  preser- 
vation of  the  full  degree  of  sensibility  of  the  glans,  and 
that  circumcision,  by  allowing  the  glans  to  be  con- 
stantly exposed  to  the  atmosphere  and  to  friction 
from  the  clothmg,  has  the  effect  of  toughening  the 
delicate  membrane  covering  it  and  of  diminishing  its 
sensibility.  It  acts  just  as  exposure  to  all  kinds  of 
weather  and  hard  manual  labor  do  on  hands  that  have 
hitherto  been  kept  gloved,  and  which  have  done  no 
work.  The  skin  is  rendered  thick  and  rough  and  the 
tactile  sensibility  of  the  fingers  is  greatly  lessened. 
The  ends  of  the  fingers  of  a  man  who  has  never  done 
any  hard  work  will  distinguish  the  two  points  of  an 
assthesiometer  at  less  than  -^  of  an  inch  apart,  while 
those  of  a  bricklayer,  for  instance,  can  not  feel  the  two 
points  at  double  that  distance. 

Extrcine  narrowness  of  the  prepuce,  by  which  there 
exists  an  impossibility  of  uncovering  the  glans,  is  an 
effectual  bar  to  the  pleasure  of  sexual  intercourse. 
For  this  condition,  an  operation,  either  of  circumcision 
or  of  slitting  up  the  prepuce,  removes  the  difficulty, 
and  in  a  short  time  the  sensibility  of  the  glans,  if  not 
always  existing,  is  developed  to  its  normal  extent. 

I  have  seen  one  case  of  insensibility  of  the  glans 
which  was  apparently  the  result  of  frequent  and  long- 
continued  immersion  in  the  sea.  The  patient  was  a 
Jewish  gentleman,  and  one  summer,  while  residing  at 
the  sea  shore,  it  was  his  habit  to  take  three  baths  in  the 


274  SKXUAL  iMrorioxLE  ix  tiik  male. 

ocean  each  day,  remaining  in  the  water  about  an  hour 
each  time.  Whether  this  was  the  cause  of  his  partial 
impotence  from  insensibility  of  the  glans,  which  came 
on  gradually  before  the  summer  was  over,  may  admit 
of  some  question,  but  the  relation  of  cause  and  effect 
seems  probable.  By  keeping  the  glans  enclosed  in  the 
end  of  a  condom,  having  previously  lubricated  it  well 
with  vaseline,  the  sensibiHty  was  restored  in  the  course 
of  a  couple  of  months. 


SECTION  II. 


Sexual  Impotence  in  the  Female. 


ABSENCE   OF   SEXUAL  DESIRE.  277 


SECTION  II. 

It  has  been  asserted  by  those  who  have  regarded  the 
matter  superficially  that  impotence  can  only  exist  in 
the  female  by  reason  of  mere  mechanical  impediment. 
We  have  seen  in  the  preceding  section  that  there  are 
other  causes  of  impotence  in  the  male  than  such  as  are 
physical  in  their  character,  and  that  the  like  is  the  case 
also  in  the  female  sex  will  be  readily  apparent  on  a 
little  reflection  and  a  consideration  of  the  several  ele- 
ments of  normal  sexual  intercourse. 

Adopting,  therefore,  the  classification,  so  far  as  it  is 
applicable,  under  which  impotence  in  the  male  is  con- 
sidered in  this  treatise,  we  have  as  the  causes  of  the 
like  condition  in  females: 

1.  Absence  of  sexual  desire. 

2.  Inability,  by  reason  of  physical  conditions,  to  al- 
low of  the  entrance  of  the  penis  into  the  vagina. 

3.  Absence  of  the  ability  to  experience  the  sexual 
orgasm. 


278  SEXUAL   IMPOTENCE    IX    THE   FEMALE. 

CHAPTER  I. 

ABSENCE   OF   SEXUAL   DESIRE. 

In  the  consideration  of  this  division  of  the  subject  it 
must  be  borne  in  mind  that  women  as  a  sex  exhibit  far 
less  intensity  of  sexual  desire  than  do  men.  As  an 
English  writer  has  remarked,  it  is  well  for  the  sanctity 
of  the  family  that  it  is  so.  The  education  of  women  in 
civilized  communities,  and  the  restrictions  imposed 
upon  them  by  the  customs  of  society,  are,  moreover, 
often  such  as  to  stand  in  the  way  of  the  development 
of  the  sexual  appetite.  It  would  be  well  for  the  future 
of  the  human  race  if  a  like  retardation  could  be  ac- 
complished in  males. 

a.  Lack  of  sexual  desire  in  women  may  be  the  result 
of  absence  or  arrest  of  development  of  the  clitoris.  It  is  doubt 
ful  if  the  first  of  these  conditions  ever  exists  as  an  ori- 
ginal defect.  It  is  not  infrequently  in  our  day  produc- 
ed by  the  surgeon,  and  among  certain  savage  nations 
it  is  brought  about  by  the  law  of  custom. 

In  those  cases  that  have  come  under  my  observation 
in  which  the  clitoris  has  been  removed  by  surgical 
operation,  while  there  has  been  a  notable  diminution  of 
sexual  desire,  there  has  been  no  absolute  loss  of  this 
appetite.  While  it  is  probably  true  that  without  the 
possession  of  the  peculiar  sensibility  with  which  the 
clitoris  is  endowed  the  desire  for  sexual  intercourse 


ABSKNCE    OV   SEXUAL   DESIRE.  2/9 

would  be  at  its  minimum,  it  is  equally  a  fact  that  the 
feeling  in  question  is  often  of  mental  origin,  and  that 
the  generative  organs  play  a  secondary  part,  so  far  at 
least  as  concerns  the  sequence  of  sensations.  A.  look, 
a  touch,  a  thought  may  be  the  starting  point. 

Besides,  it  is  very  certain  that  the  clitoris  is  not  the 
only  one  of  the  parts  constituting  the  organs  of  genera- 
tion by  the  excitation  of  which  sexual  desire  can  be  de- 
veloped, for  the  lining  membrane  of  the  vagina  and  of 
nearly  the  whole  vulva  are  similarl}^  endowed,  though 
in  a  much  less  degree.  Indeed,  there  are  reasons  for 
believing  that  the  neck  and  mouth  of  the  uterus  are 
supplied  with  sensibility  like  in  cliaracter  to  that  pos- 
sessed by  the  clitoris. 

Extreme  sinallness  of  the  clitoris  is  likewise  a  cause  of  ab- 
sent or  deficient  sexual  desire.  Several  cases  in  which 
this  abnormalitv  existed,  have  come  under  my  notice, 
and  in  all  it  was  the  apparent  cause  of  the  frigidity  that 
existed.  In  one  of  these  the  clitoris  was  scarcely  larger 
than  a  mustard  seed,  and  in  the  possessor,  a  married 
woman,  twenty-two  years  of  age,  there  had  never  been 
experienced  the  slightest  disposition  toward  inter- 
course. She  was  of  a  mild  temperament  in  all  other 
respects,  affectionate  in  her  nature,  and  devotedly  at- 
tached to  her  husband.  Intercourse  was  not  disgust- 
ing, as  it  is  to  some  women,  but  while  she  passively 
submitted  herself  to  her  husband's  wishes,  there  was 
not  the  slightest  desire  excited  by  his  caresses.  At 
times  a  slight  feeling  of  pleasure  was  developed  in  the 


28o  SEXUAL   IMPOTENCE   IN   THE   FEMALE. 

external  generative  organs,  but  this  was  not  sufficient 
to  produce  a  wish  for  a  continuance  of  the  act,  and  in  a 
little  while  it  disappeared. 

Of  course  such  cases  as  these  of  absence  and  small- 
ness  of  the  clitoris  are  quite  beyond  the  reach  of  reme- 
dial measures.  Roubaud*  is  guardedly  disposed  to 
recommend  that  as  in  accordance  with  a  well-known 
physiological  law  an  organ  is  developed  in  direct  pro- 
portion to  its  usage,  erotic  excitations,  either  moral  or 
physical,  should  be  employed.  Such  means,  however, 
it  appears  to  me — and  doubtless  all  medical  men  in  this 
country  will  agree  with  me — are  altogether  inadmis- 
sible. No  woman  could  emplo}'  them  herself,  or  sub- 
mit to  their  use  by  others,  without  incurring  the  risk 
of  utter  demoralization.  Besides,  I  think  it  exceedingly 
doubtful  that  the  clitoris,  like  a  muscle,  increases  in 
size  by  use.  The  muscular  tissue  under  the  action  of 
the  will  undergoes  contraction  and  in  the  process  is 
consumed,  new  substance  taking  the  place  of  the  old, 
and  almost  invariably  in  excess  of  the  requirements  ol 
the  occasion.  But  with  the  clitoris  and  other  erectile 
organs  no  such  active  metamorphosis,  regressive  or 
progressive,  takes  place,  and  hence  there  is  no  surplus 
of  new  formation.  There  is  no  evidence  to  show  that 
tlie  clitoris  is  larger  in  those  women  who  indulge  to 
great  excess  in  sexual  intercourse,  or  in  masturbation, 
than  it  is  in  others  who  are  temperate  or  even  entirely 
abstinent.     It  is  only  when  the  organ  is  not  present  or 

*Op.  cit.  p.  453. 


ABSENCE   OF  SEXUAL  DESIRE.  28l 

is  abnormally  small  that  there  is  a  lack  of  sexual  de- 
sires. Doubtless,  if  in  such  cases  the  most  extensive 
course  of  manual  excitation  were  resorted  to,  there 
would  not  be  the  slightest  result  so  far  as  the  increase 
of  the  size  of  the  clitoris  is  concerned, 

b.  There  are  instances  of  lack  of  sexual  desire  for 
which  no  such  cause  as  the  one  just  considered  can  be 
found,  or  in  fact  any  other  cause.  This  I  shall  desig- 
nate original  absence  of  sexual  desire. 

Roubaud  expresses  doubt  in  regard  to  the  existence 
of  idiopathic  absence  of  sexual  desire  in  women,  and 
asserts  that  no  case  of  the  kind  has  ever  come  under 
his  observation.  But  although  such  instances  are 
probably  rare,  there  is  no  question  in  my  mind  that 
they  are  occasionally  met  with,  and  due  to  inherent  de- 
fect of  organization,  independent  of  any  obvious  cause, 
and  by  reason  of  which  sexual  desire  does  not  exist.  ^ 
This  condition  Roubaud  calls  "  organic  idiopathic  frig- 
idity." Not  only,  he  asserts,  have  no  cases  of  this 
kind  come  under  his  notice,  but  he  states  that  he  has 
not  been  able  to  discover  them  in  the  writings  of 
others.  Whenever  women  have  asserted  that  they 
have  never  experienced  sexual  desire  he  has  always 
found  the  cause  to  exist  either  in  moral  circumstances 
or  in  general  or  local  conditions  affecting  the  genera- 
tive apparatus.  That  this  view  is  erroneous  will,  I 
think,  be  shown  by  a  consideration  of  the  following 
cases. 

Mrs.  C.  had  been  married  two  years  when  she  con 


282  SEXUAL   IMPOTENXE    IN    THE   FEMALE. 

suited  me.  During  that  period  she  had  never  had  the 
slightest  development  of  the  sexual  appetite,  nor  during 
her  whole  life  had  she  experienced  any  feeling  of  de- 
sire. She  was  at  the  time  I  saw  her  about  twenty-five 
years  old;  was  well  formed,  and  of  healthy  appearance. 
She  had  never  had  any  serious  illness,  except  scarlet 
fever  in  early  childhood;  had  menstruated  at  sixteen, 
and  had  always  been  regular  with  her  periods.  On  ex- 
amination, the  clitoris  was  found  to  be  as  well  develop- 
ed as  it  is  in  the  majority  of  women;  the  ovaries  could 
be  distinctly  felt,  and  were  apparently  normal,  and  the 
uterus  was  of  full  size.  Sexual  intercourse  had  never 
been  painful  to  her,  but  was  productive  of  no  pleasur- 
able sensations.  She  had  never  experienced  the  or- 
gasm. The  tactile  sensibility  and  the  ability  to  feel 
pain  were  not  below  the  normal  standard  in  any  part 
of  the  external  organs  of  generation.  She  had  always 
yielded  willingly  to  the  wishes  of  her  husband,  and 
was  anxious  to  be,  as  she  said,  "  like  other  women." 
Various  devices  had  been  tried  with  the  object  of  de- 
veloping sexiud  desire,  but  the  only  effect  had  been  to 
inspire  her  with  a  feeling  of  disgust.  She  loved  her 
husband,  and  was  anxious  to  do  all  in  her  power  to 
please  him,  hence  her  visit  to  me.  I  was  gbliged,  how- 
ever, to  tell  her  that  I  thought  her  case  out  of  the 
reach  of  medical  science.  As  well  might  1  have  at- 
tempted to  change  the  color  of  her  hair.  But  as  the 
hair  does  occasionally  undergo  a  radical  alteration  of 
hue,  I  told  her  that  it  was  barely  possible  that  through 


ABSENCE   OF   SEXUAL   DESIRE.  283 

the  action  of  natural  though  unknown  causes  she  might 
experience  the  reHef  she  sought.  In  answer  to  her  in- 
quiry, I  told  her  that  I  saw  no  reason  why  she  might 
not  become  pregnant,  and  in  fact  some  two  or  three 
years  thereafter  she  had  a  child,  and  her  husband  in- 
formed me  that  she  was  beginning  to  acquire  sexual 
desire. 

In  such  a  case  as  this  it  appears  that  the  most  rational 
explanation  of  the  absence  of  sexual  desire  and  its  sub- 
sequent acquirement  is  to  be  found  in  the  view  that  the 
system,  so  far  as  regards  the  faculty  in  question,  is  re- 
tarded in  development.  We  see  very  frequently  that 
certain  mental  characteristics  make  their  appearance 
at  a  comparatively  late  period  of  life,  and  there  is  no 
reason,  so  far  as  I  can  perceive,  why  a  like  condition 
may  not  exist  as  regards  the  sexual  appetite. 

In  the  following  case,  however,  this  explanation  does 
not  apply. 

Mrs.  O.,  thirty-five  years  of  age,  and  married  for 
over  fifteen  3^ears,  had  never  experienced  sexual  desire. 
There  were  no  evidences  of  organic  disease  or  malfor- 
mation of  any  part  of  the  generative  apparatus.  There 
was  no  aversion  to  sexual  intercourse,  and  at  times  she 
had  derived  pleasurable  sensations  therefrom,  but  this 
did  not  excite  desire  for  a  repetition  of  the  act;  neither 
did  the  caresses  of  her  husband  develop  erotic  feelings. 
Menstruation  was  regular,  both  as  regards  time  and 
quantity,  and  the  general  health  has  always  befen  ex- 
cellent. 


284  SEXUAL   IMPOTENCE   IN    THE   FEMALE. 

In  this  case  there  was  nothing  but  original  defect  of 
organization  to  which  the  lack  of  sexual  desire  could 
be  attributed.  As  we  do  not  know  in  what  part  of  the 
nervous  system  the  sexual  appetite  is  situated  it  is  im- 
possible to  locate  the  abnormality.  There  appears  to 
be  no  indication  for  treatment,  for  no  part  )f  the  gen- 
erative apparatus  seems  to  be  at  fault. 


PATHOLOGICAL   OBSTACLES.  285 


CHAPTER   II. 

INABILITY    BY    REASON    OF    PATHOLOGICAL    OBSTACLES 

TO   ALLOW   OF   THE   ENTRANCE   OF   THE 

PENIS   INTO   THE   VAGINA. 

The  causes  coming  under  this  category  that  prevent 
copulation  may  be  arranged  under  two  heads. 

a.  Abnormal  conformation  of  the  external  sexual 
organs. 

b.  Acquired  diseased  conditions  of  the  external 
sexual  organs. 

a.     This  division  of  the  subject  includes  : 

1st.     Abnormal  states  of  the  vulva. 

Absence  of  the  vulvar  opening  has  been  observed  in  a 
very  few  instances  in  conjunction  with  other  serious 
malformations,  such  as  obliteration  of  the  vagina,  in 
whole  or  in  part.  In  these  cases  there  are  neither  labia 
majora  or  minora  or  clitoris,  but  the  part  presents  a 
smooth  united  surface  devoid  of  hair.*  Occasionally 
instances  occur  in  which  the  vulva,  while  containing 
all  the  organs,  is  very  imperfectly  developed,  remain- 
ing during  adult  life  as  small  as  it  was  in  infancy. 

Again,  there  are  other  abnormalities  of  development 
which  are  more  curious  from  a  pathological  point  of 
view  than  they  are  of  interest  in  connection  with  the 
present  subject.     These  consist  of  various  forms  of  ar- 

*Roubaud.     Op.  cit.  p.  386. 


286  SEXUAL   IMPOTEN'CE   IN   THE   FEMALE. 

rest  of  development  of  the  vulva  and  the  anus,  and  of 
the  vulva  and  the  bladder. 

All  the  conditions  mentioned  are  entirely  beyond  the 
reach  of  remedial  measures,  and  are  such  as  effectually 
to  prevent  sexual  intercourse.  But  there  are  others  in 
which  there  is  hope  for  relief  by  means  of  surgical  in- 
terference, such  as  those  cases  in  which  the  vagina 
while  present  does  not  open  externally,  and  in  which  it 
may  be  reached  by  the  knife  and  a  practicable  entrance 
made.  No  general  rules  can  be  laid  down  in  regard  to 
the  exact  nature  of  the  operation  to  be  performed. 
Each  individual  case  must  be  judged  by  itself. 

Occlusion  of  the  vulva  to  such  an  extent  as  to  prevent 
the  introduction  of  the  male  organ  is  not  very  infre- 
quent. It  may  depend  upon  a  vicious  conformation  of 
the  pelvis  by  which  the  vagina  is  compressed  in  one  of 
its  diameters,  or  upon  the  existence  of  congenital  ex- 
ostoses bv  means  of  which  the  pelvic  opening  is  more 
or  less  occluded,  and  the  vagina  correspondingly  di- 
minished in  calibre.  In  these  cases  nothing  in  the  way 
of  remedial  interference  is  admissible. 

The  entrance  into  the  vagina  may  be  closed  wholly 
or  in  part  by  various  abnormalities  of  the  soft  parts. 
Thus  the  labia  may  be  adherent  or  may  be  of  such  a  size 
as  to  materially  interfere  with  the  entrance  of  the  penis 
into  the  vagina.  Adhesions  either  of  the  great  or  small 
lips  are  not  generally  unamenable  to  relief  by  surgical 
means.  These  may  consist  either  in  the  use  of  the  bis- 
toury or  of  its  handle,  or  of  simple  traction,  according 


rATlIOLOGICAL    OBSTACLES.  28/ 

to  the  completeness  of  the  adhesion.  When  redundant, 
as  they  are  apt  to  be  in  the  women  of  Africa,  and  as 
they  occasionally  are  in  those  of  more  temperate  zones, 
they  may  be  readily  excised.  The  labia  are  also  sub- 
ject to  morbid  growths  of  various  kinds,  which,  by 
their  size,  ma}-  interfere  with  the  normal  performance 
of  the  act  of  sexual  intercourse.  These  also  generally 
require  the  use  of  the  knife,  the  ligature  or  of  some 
escharotic  according  to  their  character.  Encysted  tumors 
of  the  labia  may  be  treated  by  excision  of  a  portion  of 
the  sac,  evacuation  of  the  contents,  and  the  cauteriza- 
tion of  the  walls  with  the  tincture  of  iodine  or  a  solu- 
tion of  either  the  nitrate  of  silver  or  of  the  chloride  of 
zinc.  Entire  ablation  is,  however,  the  only  operation 
which  entirely  guards  against  a  reappearance. 

Hydrocele  of  the  labia  majora  may  exist  either  on 
one  or  both  sides.  It  is  to  be  treated  in  the  same  way 
as  the  like  disease  in  man  affecting  the  tunica  vaginalis 
testis. 

Vegetations,  syphilitic  or  resulting  from  the  puerperal 
state,  may  be  so  profuse  as  to  prevent  sexual  inter- 
course. For  the  former  the  actual  cautery  or  the  liga- 
ture should  be  employed.  The  latter  disappear  spon- 
taneously after  the  state  of  pregnancy  is  accomplished. 

Hernia  of  the  labia  majora  may  exist  in  consequence 
of  the  protrusion  of  a  portion  of  the  abdominal  con- 
tents through  the  inguinal  canal,  and  may  be  so  large 
as  to  prevent  the  intromission  of  the  penis.     It  is,  of 


288  SEXUAL   IMPOTENCE   IN   THE   FEMALE. 

course,  to  be  treated  according  to  the  surgical  princi- 
ples applicable  to  such  cases. 

The  clitoris  may  be  of  such  size  as  to  interfere  ma- 
terially with  the  normal  performance  of  the  act  of  sex' 
ual  intercourse.  Cases  are  on  record  in  which  it  is  re- 
ported that  the  organ  was  of  the  dimensions  of  the 
penis,  but  these  statements  are  scarcely  worthy  of 
credit.  Probably  the  size  has  never  exceeded  that  of 
the  thumb,  unless  the  augmentation  has  been  due  to 
acquired  hypertrophy  or  the  growth  of  tumors.  In 
any  case  the  excision  of  the  organ  may  be  performed, 
if  the  circumstances  are  such  as  to  require  the  opera- 
tion. 

The  vagina  may,  as  I  have  already  stated,  be  absent, 
or  it  may  exist  in  a  more  or  less  complete  form.  In 
some  of  these  cases  there  is  an  entire  absence  of  the 
uterus  also.  The  propriety  of  an  operation  must  be 
determined  from  a  consideration  of  the  conditions  ac- 
companying each  individual  case  and  should  be  more 
or  less  tentative  in  character.  In  those  cases  in  which 
the  vagina  terminates  below  in  a  cul  de  sac  much  may 
often  be  done  by  the  surgeon  for  the  relief  of  the  pa- 
tient. When  the  organ  is,  however,  absent,  and  especi- 
ally in  those  cases  in  which  there  is  no  uterus,  opera- 
tive interference  can  scarcely  be  justifiable. 

Narrowness  of  the  vagina  to  such  an  extent  as  to  im- 
pede sexual  intercourse  is  by  no  means  an  uncommon 
occurrence.  It  is  the  one  of  all  those  abnormal  condi- 
tions  mentioned  for  which    relief  is  most   apt  to  be 


PATHOLOGICAL   OBSTACLES.  289 

sought.  Fortunately,  however  unpromising  the  case 
may  appear  to  be,  it  rarely  happens  that  sufficient 
amelioration  cannot  be  effected. 

At  times  the  constriction  is  confined  to  a  limited  part 
of  the  vagina;  at  others,  and  usually,  it  involves  the 
whole  length  of  the  canal.  Roubaud*  cites  two  inter- 
esting cases. 

The  first  is  that  of  a  young  woman  whose  vagina  was 
so  narrow  as  scarcely  to  admit  of  the  passage  of  a 
goose  quill.  At  each  menstrual  period  she  experienced 
a  strong  and  painful  sense  of  tension  in  the  womb,  and 
the  flow  took  place  slowly  and  with  difficulty.  At  the 
age  of  sixteen  she  was  married  to  a  young  and  vigor- 
ous man,  whose  embraces  she  was  not  able  to  receive. 
Visited  by  physicians,  she  was  declared  by  them  to  be 
incapable  of  having  sexual  intercourse.  Nevertheless, 
after  eleven  years  of  impotence  and  sterility,  and  with- 
out the  vagina  increasing  in  diameter,  this  woman  be- 
came pregnant.  Her  state,  as  may  well  be  imagined, 
inspired  her  friends  with  the  utmost  concern,  for  it  was 
forseen  that  labor  would  be  impossible  by  the  natural 
passage.  But  towards  the  fifth  month  of  pregnancy 
the  vagina  began  to  dilate,  and  by  the  time  delivery 
was  expected  it  had  acquired  such  dimensions  as  to  ad- 
mit of  the  birth  of  the  child. 

In  another  woman  the  vagina  was  as  greatly  con- 
stricted throughout  its  whole  extent  as  in  the  case  just 
mentioned.     She  was  also  married  to  a  man  of  strong 

Op.   cit.,  page  403. 


290  SEXUAL   IMPOTENCE    IX   THE    FEMALE. 

sexual  desires,  but,  owing  to  her  unfortunate  condition 
she  was  unable  to  submit  herself  to  his  approaches,  and 
the  marriage  was  about  to  be  declared  null  and  void, 
when  the  physician  who  was  consulted  put  in  practice 
the  following  described  procedure:  First,  he  employ- 
ed emollient  fomentations;  then  he  introduced  a  pes- 
sary of  gentian  root  throughout  the  whole  extent  of 
the  canal,  and  increased  it  in  size  till  at  last  he  could 
pass  one  made  of  the  pith  of  corn-stalk.  Finall}-  he 
introduced  a  piece  of  compressed  sponge.  These 
several  substances  imbibing  the  vaginal  secretions  so 
dilated  the  vagina  that  it  became  ample  for  all  its  func- 
tions. 

A  like  course  of  treatment  would  probably  be  fol- 
lowed by  beneficial  results  in  all  similar  cases.  It 
would  be  well,  however,  to  substitute  the  stem  of  the 
lycopodium  for  gentian  root,  and  to  use  compressed 
sponge  for  the  subsequent  treatment.  There  are  also 
various  mechanical  contrivances  acting  by  screws  in 
such  a  manner  that  their  leaves  can  be  expanded  after 
the  manner  of  one  kind  of  vaginal  speculum  so  that 
when  inserted  after  dilatation  has  been  produced  to 
some  extent  by  the  means  specified,  further  expansion 
can  be  effected. 

The  hymen  may  be  so  dense  in  structure  as  to  consti- 
tute a  real  impediment  to  sexual  intercourse,  or  the 
vaginal  canal  may  be  closed  by  one  or  more  adventitious 
membranes  placed  at  various  distances  from  the  external 
openmg.     These  cases  present  no  difficulty  for  the  sur- 


ABSENCE   OF   SEXUAL   DESIRE.  29I 

geon,  as  they  may  be  as  easily  divided  or  entirely  ex- 
cised as  the  particular  circumstances  attendant  thereon 
appear  to  require.  It  is  rarely  the  case  that  the  proper 
operative  interference  has  not  been  secured  before 
womanhood  is  reached,  or  at  any  rate  when  the  men- 
strual flow  is  about  to  take  place.  It  is  to  provide  for 
the  exit  of  the  catemenia  rather  than  for  the  act  of  sex- 
ual intercourse  that  membranes  closing  the  vagina  are 
incised  or  cut  away  altogether. 

Besides  these  conditions  there  are  others  which, 
though  not  preventing  sexual  intercourse,  are  of  such 
a  character  as  to  render  the  act  painful,  and  hence  un- 
natural. It  is  scarcely  necessary  to  do  more  than  to 
refer  to  these.  Among  them  are  vesico-vaginal  and 
recto-vaginal  frstulge,  syphilitic  and  other  ulcerations, 
vaginitis  and  various  wounds  and  injuries.  These  are, 
of  course,  to  be  treated  according  to  the  general  prin- 
ciples of  surgery.  It  is  rarely  that  the  physician  or 
surgeon  is  called  upon  to  treat  them  as  causes  of  sex- 
ual impotence. 


292  SEXUAL   IMPOTE^XE    I\    THE    FEMALE. 


CHAPTER  III. 

VAGINISM. 

Although  the  condition  to  which  the  late  Doctor 
Marion  Sims  gave  the  designation  vaginism  was  known 
before  he  wrote  upon  the  subject,  it  is  this  distinguish- 
ed physician  to  whom  we  owe  the  first  complete  and 
systematic  account  of  a  disease  which  is  of  all  others 
the  most  common  as  a  cause  of  female  sexual  im- 
potence. Dr.  Sims""  defined  vaginism  as  an  excessive 
hyperassthesia  of  the  hymen  and  vulva  associated  with 
such  a  degree  of  spasmodic  and  involuntary  contrac- 
tion of  the  sphincter  vaginae  as  to  prevent  sexual  inter- 
course. This  definition  gives  in  short  compass  the 
most  prominent  symptoms  of  the  opposition,  which  are 
pain  and  spasm,  on  coition  being  attempted,  or  indeed 
when  any  foreign  body,  as  the  finger,  for  instance,  is 
introduced  into  the  vagina.  Nevertheless,  there  are 
occasionally  cases  met  with  in  which  the  pain  is  situat- 
ed either  above  or  below  the  hymen,  which  is  not  the 
seat  of  special  tenderness.  Again,  the  sphincter  va- 
ginee  is  not  the  only  muscle  in  which  spasmodic  con- 
tractions are  observed,  and  at  times  they  are  altogether 
absent,  the  excessive  hyperaesthesia  constituting  the 
only  marked  symptom  of  the  affection. 

*  Transactions  of  the  Royal  Obstetric  Sociery,  1862. 


PATHOLOGICAL   OBSTACLES.  293 

Sir  James  Simpson*  regards  the  disease  as  being  due 
to  a  state  of  hyperagsthesia  of  the  pudic  nerve,  while 
Dr.  Graillj  Hewittf  considers  that  the  disorder,  while 
not  always  due  to  the  same  cause,  is  essentially  the  re- 
sult of  a  local  alteration  or  irritation  of  the  nerves  at 
the  spot  itself.  However  this  may  be,  there  is  in  my 
opinion  no  doubt  that  vaginism  is  a  consequence  of 
some  disorder  of  the  nervous  system,  and  that  this  is  in 
a  large  proportion  of  cases  located  in  the  spinal  cord 
constituting  the  condition  known  as  spinal  irritation,  or 
anasmia  of  the  posterior  columns  of  the  spinal  cord. 

A  characteristic  of  the  pain  and  spasm  of  vaginism  Is 
the  fact  that  they  are  more  strongly  marked  on  a  slight 
touch  of  the  affected  parts  than  when  steady  pressure 
is  made.  I  have  had  cases  under  my  charge  in  which 
the  introduction  of  the  finger  or  even  of  a  sound  into 
the  vagina  would  cause  the  greatest  agony,  while  two 
or  three  fingers  if  held  in  position  firmly  produced  very 
little  suffering.  In  these  instances  the  intromission  of 
the  penis  was  not  accompanied  by  much  local  disturb- 
ance so  long  as  the  organ  was  kept  in  a  state  of 
quietude.  So  soon,  however,  as  friction  of  the  penis 
against  the  vaginal  walls  was  produced,  the  pain  be- 
came insupportable,  and  efforts  at  intercourse  had  to  be 
brought  to  an  end. 

It  is  not  surprising  that  women  suffering  from  vagin- 

*  Clinical  Lecture  on  the  Diseases  of  Women.  New  York:  1871, 
page  284. 

f  Diseases  of  Women.  Second  American  edition.  Philadelphia: 
1873,  p.   706. 


294  SEXUAL   IMP(3TEXCE    IX    THE    FEMALE. 

ism  shudder  at  the  very  idea  of  sexual  intercourse.  Ex- 
perience has  taught  them  that  the  pain  and  distress  are 
greater  than  any  that  they  have  previously  had  to  en- 
dure. In  consequence  they  soon  renounce  all  attempts 
of  the  kind,  and  eventually,  if  not  relieved,  no  matter 
how  erotic  they  may  have  been,  lose  all  desire  of  a  vener- 
eal character. 

Vaginism  is  not,  of  course,  limited  in  its  influence  to 
the  matter  ol  sexual  intercourse.  Derangements  of  men- 
struation, leucorrhoea,  and  various  abnormal  mental 
conditions  approaching  and  even  reaching  the  state  of 
actual  insanity  are  often  produced.  With  these,  how- 
ever,  we  need  not  concern  ourselves  at  this  time. 

So  far  as  copulation  is  concerned,  the  two  disturbing 
factors  are,  as  we  have  already  seen,  pain  and  spasms. 
These  may  exist  in  various  proportions  relative  to  each 
other.  In  some  cases,  if  the  woman  can  endure  the 
pain,  intercourse  is  possible,  for  there  is  little  or  no 
spasm  of  the  sphincter  vaginas.  In  others  the  spasm  is 
the  main  feature,  the  slightest  touch  being  sufficient  to 
develop  it,  while  there  is  a  minimum  of  pain.  In  this 
respect  the  vagina  appears  to  be  not  unlike  the  urethra, 
which  in  some  cases  closes  spasmodically  as  soon  as  an 
effort  at  passing  a  catheter  or  sound  is  made. 

Vaginism  rarely  makes  its  appearance  before  puberty, 
and,  indeed,  it  may  be  said  that  in  the  vast  majority  of 
cases  it  does  not  arise  except  during  the  generative 
period  of  the  woman.  It  is,  therefore,  not  often  seen 
after  the  cessation  of  the  menses,  nor  before  copulation 


PATHOLOGICAL   OBSTACLES.  295 

has  taken  place.  In  those  cases  of  early  development 
of  the  affection  the  first  evidence  of  its  existence  is  gen- 
erally obtained  by  the  patient  herself  through  her  own 
sense  of  touch  during  bathing  or  otherwise. 

Among  its  predisposing  causes  hysteria  probably 
stands  first.  It  is  very  doubtful  whether  it  is  induced 
directly  by  sexual  excesses  or  by  masturbation,  though 
I  have  had  one  case  under  my  charge  in  which,  ap- 
parently it  owed  its  origin  to  the  repeated  introduction 
for  masturbatory  purposes,  of  foreign  bodies  into  the 
vagina.  In  like  manner  cases  are  met  with  in  which  a 
disproportion  between  the  dimensions  of  the  penis  and 
those  of  the  vagina  is  the  most  obvious  cause.  Not 
long  ago  a  lady  consulted  me  for  the  affection  in  ques- 
tion who  a  month  previously  had  been  married  to  her 
second  husband,  a  strong  and  passionate  man.  She 
had  never  experienced  any  discomfort  from  sexual 
intercourse  with  her  first  husband,  but  with  the  present 
one  the  act  had  from  the  first  been  painful,  and  latterly 
had  become  insupportable,  and  almost  impossible. 
Examination  revealed  the  true  state  of  affairs.  There 
was  extraordinary  hypersesthesia  at  the  situation  of  the 
carunculce  mytriformes,  and  strong  spasm  of  the 
sphincter  vaginse  on  the  attempt  to  introduce  the 
finger.  Suitable  inquiries  revealed  the  fact  that  the 
disproportion  in  size  between  the  sexual  parts  of  herself 
and  her  husband  was  such  that  intercourse  had  never 
been  satisfactory  to  either  party.  She  was  quite  sure 
that  to  that  cause,  and  to  that  alone  the  vaginism  was 


296  SEXUAL    IMPOTENXE    IN    THE    FEMALE. 

due.  There  was  no  marked  narrowness  of  the  vagina, 
so  that  the  misfortune  was  not  of  her  making.  I  re- 
quested her  to  send  her  husband  to  me,  and  then,  on 
inspection  of  the  parts  concerned,  found  that  there  was 
no  doubt  as  to  where  the  responsibility  should  be 
placed. 

But  such  causes  are  only  capable  of  developing 
vaginism  in  a  woman  in  whom  the  predisposition  al- 
ready exists,  and  often  this  predisposition  is  so  strong 
that  no  other  influence  than  that  of  copulation  is  neces- 
sary to  the  complete  establishment  of  the  affection. 
The  h3-sterical  diathesis,  for  instance,  undoubtedly  has 
great  influence  in  promoting  vaginism,  and  is  of  still 
greater  power  in  spinal  irritation,  when  the  seat  of  the 
disease  is  in  the  lumbar  region  of  the  cord. 

In  regard  to  the  spinal  origin  of  many  cases  of  vagin- 
ism my  experience  is  very  decided.  It  is  rarely  the 
case  that  in  vaginism  we  do  not  also  find  tenderness  of 
the  lumbar  portion  of  the  spinal,  and  many  of  the  other 
symptoms  associated  with  anaemia  of  the  posterior 
columns  of  this  region  of  the  cord. 

The  treatment  of  vaginism  is  as  satisfactory  as  that  of 
any  other  disease  known  to  science.  Indeed,  with  our 
present  knowledge  of  the  nature  of  the  affection,  and 
of  the  therapeutical  actions  of  remedies,  failure  to  cure 
a  case  of  the  disease  is  almost  out  of  the  question. 
Without  touchmg  upon  doubtful  remedies,  or  men- 
tioning those  that  might  from  theoretical  reasons  be 
beneficial,  I  shall  briefly  describe   the   plan   of   treat- 


PATHOLOGICAL   OBSTACLES.  297 

ment  which  has  been  uniforml}-  successful  in  my 
hands. 

In  the  fii"st  place,  the  parts  should  be  freely  bathed 
with  a  lo-per-cent.  solution  of  the  hydrochlorate  of  co- 
caine, and,  after  the  morbid  hyperassthesia  is  in  a 
measure  subdued,  a  plug  of  lint,  saturated  with  the 
solution,  should  be  inserted  into  the  vagina  and  kept 
in  place  with  another  of  dr}-  lint.  These  should  be 
changed  twice  daily  for  fresh  ones. 

With  the  institution  of  these  measures  a  large  dose 
of  the  bromide  of  sodium,  potassium  or  ammonium 
should  be  administered.  I  generally  give  from  fifty  to 
one  hundred  grains  in  a  third  of  a  tumbler  of  water, 
and  in  a  few  hours  begin  with  a  solution  of  an  ounce 
and  a  half  to  four  ounces  of  water,  a  teaspoonful  (about 
twenty-five  grains)  being  given  three  times  a  day. 

If  spinal  tenderness  is  discovered  to  exist  the  part  in 
question  should  be  painted  daily  with  the  tincture  of 
iodine,  or  a  blister  should  be  applied,  or  the  actual 
cautery  used,  or  sparks  drawn  from  the  region  by  the 
large  brass  ball  of  a  statical  electrical  machine  while 
the  patient  sits  on  the  insulated  stool.  If  these  latter 
measures  be  neglected,  the  disease,  although  it  will  be 
temporarily  relieved  by  the  cocaine  and  bromide,  will 
certainly  return  so  soon  as  the  influence  of  these  agents 
has  passed  off. 

When  a  disproportion  in  size  exists  in  the  case  of  a 
married  woman  between  the  sexual  organs  of  herself 
and  her  husband,  means  should  be  taken  to  overcome 


29<S  SEXUAL    IMPOTENCE    IN    THE    FEMALE. 

the  obstacle.  These  should  be  directed  to  the  matter 
of  stretching  the  vagina  so  as  to  admit  of  intercourse 
being  effected  without  pain.  This  can  be  done  while 
the  patient  is  under  the  influence  of  a  general  anses- 
thetic,  or  after  a  few  days'  treatment  with  cocaine  and 
some  one  of  the  bromides,  as  above  described,  by  the 
hand  of  the  surgeon,  or  by  means  of  an  instrument  such 
as  the  bivalve  or  trivalve  speculum.  This  method  is 
altogether  preferable  to  that  with  slowly  dilating  sub- 
stances, such  as  compressed  sponge,  gentian  root,  etc. 
In  these  cases  to  which  reference  has  been  made 
forcible  dilatation  with  the  fingers  was  effected  in  the 
manner  described,  and  with  entire  success.  Subse- 
quently the  patient  became  pregnant  and  there  was  no 
further  trouble.  Of  course  no  means  of  stretching  the 
vagina  is  comparable  to  the  passage  of  a  foetus,  but, 
unfortunately,  it  is  generally  the  case  that  the  condi- 
tion of  vaginism  is  almost  prohibitive  of  the  interven- 
tion of  pregnancy. 


INABILITY   TO   EXPERIENCE   THE   ORGASM.         299 


CHAPTER  IV. 

ABSENCE   OF   THE   ABILITY   TO   EXPERIENCE   THE 
SEXUAL    ORGASM. 

Every  physician  of  experience  is  aware  of  the  fact 
that  not  a  few  women  pass  through  married  life  ex- 
tending over  many  years  without  ever  having  felt  the 
slightest  degree  of  pleasure  from  sexual  intercourse. 
He  also  knows  that  there  are  others  who,  having 
originally  been  possessed  of  the  normal  capacity  in  this 
respect,  lose  it  very  early  in  life,  or  at  a  period  far  an- 
terior to  that  at  which  it  would  naturally  be  expected 
to  disappear. 

The  social  life  of  woman  is  such  as  to  impose  on  her 
restraints  which  do  not  exist,  with  such  full  force  at 
least,  with  the  male  sex.  She  may  he  bound  to  a 
brutal  or  otherwise  disgusting  man,  with  whom  the 
very  idea  of  intercourse  is  horrible.  The  mental  ele- 
ment enters  so  fully  into  the  act  of  coition  that  it  is  not 
surprising  that  under  such  circumstances  there  should 
be  an  entire  failure  on  the  part  of  the  woman,  when, 
perhaps,  with  a  man  capable  of  arousing  the  emotion 
of  love  a  very  different  state  of  affairs  would  result. 
This  is  a  matter  that  is  often  overlooked.  The  affec- 
tion which  may  once  have  existed  between  the  parties 
has  gone  from  one  or  both.  If  it  has  disappeared  from 
the   husband,  he  does  not  approach  his   wife  unless 


300  SEXUAL   IMPOTENCE    IX    THE    FEMALE. 

iirgfcd  thereto  by  mei^e  animal  instinct.  He  abstains 
altogether,  or  he  seeks  satisfaction  for  Iiis  emotion  and 
his  appetite  from  some  woman  capable  of  arousing- 
both.  But  with  women  the  case  is  altogether  different, 
unless  with  the  members  of  the  class  who  make  a  mer- 
chandise of  their  bodies,  and  even  with  them  the  senti- 
ment of  love,  transient  though  it  may  be,  is  often 
aroused.  With  the  rest,  it  is  doubtful  if  in  one-tenth  of 
the  instances  of  intercourse  they  experience  the  slight- 
est pleasurable  sensation  from  first  to  last.  The  virtu- 
ous married  woman  submits  passively  and  is  impotent. 
She  loses  the  power  of  accomplishing  her  part  of  the 
sexual  act;  or  if  married  through  the  force  of  circum- 
stances that  she  cannot  resist  to  a  man  she  abhors,  she 
never  experiences  the  least  pleasure  from  his  em- 
braces. On  the  contrar}-,  they  inspire  her  with 
supreme   loathing. 

In  such  cases  as  these  the  physician  can  do  nothing; 
death  or  the  divorce  court  opens  the  only  way  to  re- 
lief, and  then  a  second  and  happier  marriage  completes 
the  cure. 

There  is  another  species  of  impotence  met  with  in 
women  which,  though  not  complete,  is  distressing  and 
often  leads  to  nervous  complications  of  a  serious  char- 
acter. It  is  that  form  in  which,  with  strong  desire  and 
the  ability  to  experience  the  orgasm  in  all  its  intensity, 
this  condition  is  never  attained  for  the  reason  that  the 
man  has  reached  the  acme  while  the  woman  has  not 
arrived  at  this  point.     With  this  result  the  penis  be- 


INABILITY    TO    EXPERIEXCE    THE    OR(JAS.M.         30! 

comes  flaccid,  and  the  act  is  at  an  end  so  far  as  the  man 
is  concerned,  while  the  woman  remains  with  her 
nervous  system  excited  to  a  high  pitch,  and  brought  to 
a  state  of  expectancy  which  is  not  realized.  It  is  gen- 
erally the  case  that  women  are  slower  to  reach  the 
height  of  the  venereal  paroxysm  than  are  men.  From 
the  beginning  of  the  act  they  experience  a  certain  de- 
gree of  pleasure,  but  this  is  not  developed  to  its  utmost 
extent  as  rapidly  as  it  is  with  the  opposite  sex.  Prob- 
ably in  a  state  of  nature  there  is  no  difference  in  this 
respect  between  men  and  women,  but  civilization  has 
imposed  restrictions  on  the  development  of  the  sexual 
appetite  in  the  one  sex,  while  it  has  set  few  or  no  limits 
to  its  exercise  in  the  other.  The  consequence  is  an 
impetuosity  in  men  and  a  shrinking  delicacy  and  re- 
serve in  women.  It  often  happens  that  with  the  con- 
tinuance of  sexual  relations  this  inequality  in  a  great 
measure  disappears,  but  this  is  not  by  any  means  al- 
ways the  case,  and  many  women  with  strong  desires 
and  loving  their  husbands  go  through  life  with  scarcely 
an  idea  of  what  sexual  intercourse  really  is,  they  never 
having  experienced  to  the  full  the  pleasurable  sensa- 
tions characteristic  of  coition. 

For  many  such  cases  as  these  the  remedial  measures, 
though  they  may  not  consist  of  more  than  a  few  sensi- 
ble though  plain  spoken  words,  should  be  addressed  to 
the  husband.  If,  however,  it  appears  that  there  is  any 
necessity  for  stimulating  the  sexual  faculty  of  the  wo- 


302  SEXUAL   IMPOTENCE   IN    THE   FEMALE. 

man,    the  following  prescription  may  be   given  with 
probable  advantage: 


/ 


5     Cannabis  indicae  ext., 

Nucis  vomicae  ext.,  aa  Z  ss. 
Aloes  ext.  aquosge,  gr.  x. 

M.  ft.  pil  Xo.  C. 

Dose,  one  three  times  a  day. 


In  addition,  hot  water  vaginal  douches  should  be 
used  just  before  going  to  bed.  Under  the  use  of  these 
measures  I  have  had  patients  under  my  charge  experi- 
ence decided  benefit.  So  much  under  the  influence  of 
habit  is  the  whole  matter  of  sexual  intercourse  that  im- 
provement when  once  effected  is  likely  to  become 
permanent. 

Masturbation  is  among  the  chief  causes  of  indifference 
of  women  for  sexual  intercourse,  and  consequent  in- 
ability to  experience  the  orgasm  during  coition.  The 
reasons  for  this  effect  are  almost  identical  with  those 
given  for  a  like  condition  existing  in  men  who  have 
been  addicted  to  this  vice.  The  images  formed  by 
the  imagrination  are  so  much  more  intense  than  those 
met  with  in  actual  life  that  the  latter  do  not  produce 
the  degree  of  excitation  necessary  for  the  production 
of  the  orgasm.  This  constitutes  a  condition  of  actual 
impotence  according  to  the  system  of  classification  laid 
down  in  this  work. 

It  is  difficult  to  treat  with  success  cases  such  as  those 
now  under  consideration  even  under  the  most  favor- 
able circumstances.     It  generally  happens  that  these 


•    INABILITY   TO    EXPERIENCE   THE   ORGASM.         303 

cannot  be  obtained.  First  among  them  is  the  total 
renunciation  of  the  habit  of  masturbation;  second,  abso- 
lute rest  of  the  sexual  organs,  so  far  as  intercourse  is 
concerned,  for  a  period  long  enough  to  enable  them  to 
recover  their  lost  tone.  This  varies  in  different  cases, 
but  is  not  often  less  than  a  3-ear,  Third,  the  avoidance 
of  all  lascivious  associations  or  thoughts.  To  secure 
these  conditions  is,  as  I  have  said,  difficult.  Without 
them  it  is  scarcely  worth  while  for  the  physician  to 
undertake  the  case.  If,  however,  they  can  be  secured, 
there  is  a  fair  prospect  that  in  time  a  cure  can  be  ac- 
complished. It  will  be  facilitated  by  social  intercourse 
with  men  and  women  of  high  moral  character.  Medi- 
cines are  of  little  use  unless  there  is  some  special  indi- 
cation to  be  met.  The  treatment  is  not  so  much  physi- 
cal as  mental.  I  am  not  now  considering  the  question 
of  the  effects  of  masturbation,  except  so  far  as  they  re- 
late to  sexual  indifference  and  impotence  as  regards  the 
male  sex.  If  I  were,  there  would  of  course  be  much  to 
say  on  the  subject. 

Excessive  sexual  intercourse  is  also  productive  of  effects 
in  women  similar  to  those  which  follow  it  in  men.  In 
these  cases  the  nerve  cells  of  the  centre  presiding  over 
the  function  doubtless  become  exhausted,  and  no  longer 
properly  respond  to  the  stimulus  which  in  natural  con- 
ditions sets  them  in  action.  There  is  no  erection  of  the 
clitoris  or  of  the  other  parts  in  contiguity  that,  like  it, 
are  endowed  with  erectile  tissue;  no  development  of 
pleasure  from  the  friction  of  the  penis  against  these 


304  SEXUAL    IMPOTENCE    IN    THE    P  E.MALE. 

organs  and  the  vagina,  and  if  the  orgasm  is  reached  the 
result  is  imperfect  and  the  voluptuous  sensations  at 
their  minimum.  With  this  condition  it  sometimes  hap- 
pens that  desire  remains  as  strong  as  ever,  while  at 
other  times  it  is  extinct. 

Such  cases  are  to  be  treated  on  the  same  principles 
as  those  laid  down  in  the  first  section  of  this  work  for 
the  management  of  the  like  condition  in  men.  Chief 
among  them  is  entire  abstinence  and  the  avoidance  of 
every  factor  calculated  through  the  sight,  the  hearing, 
the  touch,  the  memory,  to  stimulate  organs  already  ex- 
hausted. At  the  same  time,  a  mild  tonic  treatment 
should  be  adopted.  The  prescription  given  on  page 
120  answers  very  well,  and  in  addition  the  wine  of  coca 
may  be  advantageously  taken— a  wineglassful  at  each 
meal.  If  the  sensibility  of  the  erectile  tissues  and  the 
lining  membrane  of  the  vagina  are  notably  diminished, 
electricity  may  be  used  with  benefit.  It  is,  in  my 
opinion,  far  superior  to  the  embrocations  recommended 
by  some  French  authorities.  These  contain  some  stim- 
ulating substance,  such  as  mustard,  ammonia,  alcohol, 
etc.,  and  may  be  used  when  electricity  is  not  available. 
The  faradaic  current  applied  by  means  of  a  wet  sponge 
placed  in  the  vulva  while  the  other  is  held  in  contact 
with  the  lumbar  or  vulvar  region,  is  an  eligible  form  of 
administering  electricity.  The  galvanic  current  may, 
however,  be  employed,  and  in  some  cases  acts  better 
than  the  faradaic. 


INABILITY    TO   EXPERIENCE   THE   ORGASM.         305 

In  all  such  instances  the  wife  should  sleep  apart  from 
her  husband,  and  preferably  in  separate  rooms.  The 
reasons  for  this  course  are  obvious,  and  need  not  there- 
fore be  further  specified. 


^:  r^  a  O  B 


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